Department of
Introduction Hepatobiliary
and Pancreatic
Breast Surgery,
Head and Neck
(Cluster Based)
Endolap OR

A dedicated operating theatre suite for endoscopic and laparoscopic surgery has been established in our unit since 2005, design of which was unprecedented in Hong Kong. It has developed an innovative concept of combining both endoscopic and laparoscopic surgeries, enabling luminal and intra-abdominal operations to be performed at the same time.

The need of development of a Endolap OR.

The explosion of laparoscopic surgery beginning in the late 1980s, has led to the proliferation of accessories including: monitors, cables, tubing, light sources, insufflators, documentation devices, and other equipment housed in the operating room on large wheeled carts.

Equipments overwhelm small operating suites. Troublesome problems also include tangling of cables, electric cords, foot pedals, and suction & irrigation tubing. This leads to inefficiency in OR turnover and are potentially hazardous to safety of patients

In parallel with laparoscopic surgery, endoscopic procedures have also demonstrated major advances in recent years.  Often, laparoscopic and endoscopic procedures are complementary, rather than competitive. Its application is well endorsed in accurate identification of gastroesophageal junction at laparoscopic anti-reflux surgery, better localization of small gastric tumors and colonic tumors for laparoscopic resection, improvement in precision of myotomy in Laparoscopic Heller’s cardiomyotomy, searching for the obscured source of gastrointestinal bleeding. In addition, the use of choledochoscope is also an invaluable tool in laparoscopic exploration of common bile duct.

The sophisticated Endo-lap OR offers a total solution with both endoscopic and laparoscopic equipment installed together in the operating theatre.

Features and Advantages of Endolap OR:

1. Ceiling mount architecture.  (Fig 1)

  • The ceiling was installed with strengthened mounting plates and suspended pendants. A full set of endoscopic and laparoscopic equipment was then mounted on the pendants in an ordered manner.
  Fig. 1. Outlook of The Endo-Lap OR. Noted the ceiling mount architecture, multiple LCD screens, the integration of endoscopic and laparoscopic instruments and their accessories.

2. Multiple LCD monitor screens: (Fig1)

  • 4 light-weight, ceiling mounted LCD monitors with easy angle adjustment joints were installed. These allow comfortable and clear views for the surgeons, assistants, and nurses in different surgical procedures, which definitely improves operation efficiency.

3. Control of information flow and open architectural concept:

  • The camera over the surgical light source and all of the LCD monitors are connected to a built-in AV matrix and teleconferencing system. This allows easy recording, documentation, and image transfer for purposes of education, teleconferencing, and live demonstration. The open architecture design of the plug-in slot allows expandability and flexibility.

4. New generation of image system:

  • The new EXTERA II 180 endoscopes (Fig. 2) provide a wide-angle view (170 degree versus 140 degree) and an extra light guide for better illumination. The system also allows a high resolution Q image and yet maintains a small outer diameter of the endoscope. This makes it possible for the endoscopist to find the next lumen with ease, and it provides better visualization. These improvements minimize the miss rate and result in less operator fatigue and stress.

Fig. 2. The new EXTERA II 180 endoscope

5. Integration of surgical equipment:

  • By the use of Endo-ALPHA (Olympus), the endoscopic and laparoscopic instrumentation is fully integrated and centralized.

6. Centralization of display and control (Fig. 3):

  • With all the equipment being integrated, necessary information such as the insufflating pressure, flow, etc are displayed and monitored with real-time status and error alarm. This allows friendly touch-screen adjustment by the nurse at the control panel.

Our Expeirence with Endolap OR.

In 2005, a retrospective review was performed in evaluating efficiency of OR and staff satisfaction.  A total of 640 cases were included in the study Period of 9 months , 245 cases of open surgery, 282 cases of laparoscopic surgery, 82 cases of endoscopic surgery, 17 cases of video-assisted thoracoscopic surgery, and 14 cases of combined endoscopic-laparoscopic surgery. There were no reported incidents of operating failure related to hardware or software problems. The overall staff satisfaction was excellent.  By June 2009, we have performed over 4800 cases in this Endolap OR suite. It provided with us the best operating environment by integration of laparoscopic & endoscopic instruments, imaging platform and energy platforms, accessorie