A planning guide for new and refurbished operating theatres: choosing between electric and electro-hydraulic tables, why carbon fibre matters for C-arm work, how to specify shadowless LED lighting, and sizing your CSSD.
An operating theatre is the most equipment-dense room in a hospital and the least forgiving of a procurement mistake. The table, the lights and the sterilisation chain are bought once and used for fifteen years. This guide covers what to specify, in what order, and which decisions are difficult to reverse after commissioning.
Every other decision follows from what will actually be operated on in the room. A general surgery theatre, an orthopaedic theatre and a theatre used for image-guided procedures need genuinely different tables. Write the caseload down before writing the specification, because the answers change:
Electric tables use motors driven from a hand control and typically hold position through the motor drive. Electro-hydraulic tables use an electrically driven hydraulic system, which generally delivers higher load capacity and very smooth movement under load. Manual hydraulic tables remain appropriate for low-volume theatres and for a hospital that needs a table that works with no power at all. Most theatres in Bangladesh are best served by an electric or electro-hydraulic table with a manual override, so that a power failure mid-procedure does not strand the patient in an unusable position.
This is the decision most often got wrong. If a C-arm will ever be used in the room, the tabletop must be radiolucent so the beam passes through without artefact, and there must be enough clear space under the top for the C-arm to travel. Carbon fibre tops give the best imaging performance and the widest unobstructed imaging area. Buying a standard stainless top for a theatre that later takes orthopaedic or vascular work means buying the table twice.
Confirm the table offers, at minimum, height adjustment, Trendelenburg and reverse Trendelenburg, lateral tilt, back section and leg section movement, and a kidney bridge or flex position if the caseload calls for it. Check the range in degrees rather than accepting that the movement merely exists.
The purpose of an operating light is to illuminate a deep, narrow cavity without casting the surgeon's own head and hands into it as shadow. Modern theatres use LED, which has effectively replaced halogen for good reasons: far lower heat at the surgical site, much longer lamp life, and stable colour temperature.
| Specification | Why it matters | What to ask |
|---|---|---|
| Shadow dilution | Multiple emitters from different angles fill in the shadow cast by the surgeon | How many independent LED emitters, and how does the head behave when partly obstructed |
| Illuminance | Too little light slows the procedure; too much causes glare and fatigue | Central illuminance in lux at one metre, and whether it is adjustable |
| Colour rendering | Tissue must look like tissue, so surgeons can distinguish structures | Colour rendering index, and whether colour temperature is adjustable |
| Light field diameter | Must match the incision size across the caseload | Is the field diameter adjustable, and across what range |
| Sterilisable handle | The surgeon repositions the light mid-procedure | Is the central handle removable and autoclavable |
| Suspension | A drifting light head is a daily irritation for fifteen years | Ceiling, wall or mobile, and how the arm holds position |
Specify a satellite head alongside the main head for most theatres. A single-head installation leaves the surgical team fighting shadow on anything deeper than a superficial procedure.
A theatre is only as safe as the instruments coming into it. Sizing the sterilisation capacity is a straightforward calculation that is frequently skipped: count instrument sets per theatre per day, multiply by the number of theatres, and add a margin for emergency work. Then confirm your steriliser can process that volume in the working day with cycle time included, not just chamber volume.