The ultra-modern and needs-based operating theatre at the Claraspital covers an area of 2900 square metres. The eight new operating theatres are so universally designed that surgeons can perform their operations flexibly in almost any operating theatre. They are supported by the most innovative room control and imaging technology, which enables them to work safely and with the best possible medical technology.
Everything in flow - the flow principle
A modern operating theatre should be efficient, patient- and staff-friendly and be able to be developed flexibly. The new operating theatre at the Claraspital is designed according to the flow principle, i.e. the processes are defined in such a way that all the necessary information and materials are available on time and in the right quantity. This avoids waiting times, duplication of work and unnecessary material consumption. In the new operating theatre area, this means continuous and intuitive workflows so that patients, staff and materials can "flow" through the operating theatre area without major disruptions.
The "patient flow"
Patients are received and repositioned in the new operating theatre zone by the positioning nurse.
They are then taken to the holding zone, where they wait for the operation and initial pre-operative preparations can be made. Minor procedures such as the insertion of a venous catheter can also be carried out there. Patients are retrieved from the holding zone shortly before the operation and taken to the preparation room for anaesthesia induction. The anaesthesia preparation room is located directly opposite the operating theatre. As soon as everything is ready for the operation, the patient is wheeled across the corridor into the operating theatre. The anaesthetists remain with the patient throughout the operation. After the operation, patients are moved back to their ward bed and taken to the recovery room, where they can recover from the anaesthetic.
The "material flow"
Based on the surgical programme, qualified logistics or AEMP staff assemble the instruments and materials required for the procedure according to a standardised list on a supply trolley, the "case trolley". These preparation lists are stored digitally and are specific to the procedure, although they can of course be adapted if necessary. However, the aim is that they should not need to be changed in at least 85 per cent of all operations.
Lean management in the operating theatre
The concept of the patient-specific supply trolley concept (case trolley) enables consistency in the processes from surgery registration, surgery planning and material provision through to seamless documentation and billing. "The concept is based on the 6R approach from lean management," explains Dr Christoph Engmann, Deputy Head of Anaesthesia. This ensures that the right material is provided in the right quantity in the right place at the right time in the right quality at the right cost.
Based on the surgical programme, the materials required for the procedure are compiled as standard and individually adapted to the patient if necessary. This contributes to patient safety and conserves resources. The case trolley concept is finding its way into more and more operating theatres. "At the Claraspital, we started with the concept back in 2015 and were able to fully implement it when we moved into the ultra-modern operating theatres in 2020," says Christoph Engmann. In terms of the process consistency of the data and material flow, the Claraspital is thus a pioneer in Switzerland.
da Vinci Xi operations
The Claraspital uses da Vinci Xi® for robot-assisted minimally invasive surgery. The latest generation system is used in urology, primarily for prostate and kidney tumours. In addition, the Clarunis team has taken on a pioneering role in robot-assisted visceral surgery: The da Vinci Xi® robot is primarily used for complex operations such as oesophagectomy, where space is limited, for example in the small pelvis, and for obese patients.
Thanks to its expertise and high case numbers, the Claraspital has been appointed a reference centre for highly specialised minimally invasive da Vinci Xi® visceral surgery: manufacturer Intuitive Surgical sends participants from its da Vinci® Technology Training Programme to the Claraspital for introductory and advanced training. The Claraspital is the first and only da Vinci Xi® reference centre in Switzerland and one of the few centres in Europe.
The da Vinci system consists of the actual robot with movable arms that carry a camera and instruments, a central computer unit and a surgical console. During the operation, the surgeon is not located directly at the operating table, as is usually the case, but controls the surgical instruments from the operating console using small movable joysticks (Fig. 2). The robot precisely implements the surgeon's manual movements in a tremor-filtered manner.
The da Vinci system offers significant advantages by improving the range of movement and precision of the instruments and contributes significantly to faster recovery and convalescence thanks to smaller skin incisions, less blood loss and less post-operative pain.