The most visible aspects of today's newly designed surgical spaces are ceiling-mounted booms, high-tech equipment and flat-panel video monitors hanging from their articulated arms, hovering inches from the surgeon's head. In addition to the improved image, data and equipment efficiencies provided by the marriage of digital control systems and surgical booms, a well-documented body of literature justifies the use of booms to improve operational efficiencies, infection control and staff safety.

Seemingly suspended in midair
If you've done the research and have decided to purchase and install booms for your ORs to get the full potential from all of the high-tech instrumentation now available, here are key selection criteria you need to consider.

• Can booms even be installed in my current facility? Ceiling-mounted equipment management systems have minimum clearance requirements both above and below the finished ceiling. They're also heavy and carry heavy loads, which means there are significant structural requirements for above the ceiling. The booms have their own electrical and medical gas requirements. You'll need to analyze all these factors before you start shopping.
• What are your current equipment management needs? The central appeal of a boom is having a centralized location for endoscopic video equipment and the elimination of the mass of cables, cords and tubing associated with these items (the spaghetti factor.) You should also consider what other equipment may work more efficiently off of the boom, such as arthroscopy pumps, RF ablation generators and or electrosurgical units. Be thoughtful in this analysis, though; just because it could go on the boom does not mean that it should go on the boom. To verify weight capacities and required utility services, your boom vendor will need a detailed list of items you have determined would go on the boom.
• What are your anticipated future equipment management needs? A boom is a 15-year purchase, based on its expected useful life. Say yours is a general-purpose surgical center, but you're currently only doing arthroscopy cases; you may want to have your boom equipped with a carbon dioxide gas connection and shelf space for the future addition of a laparoscopic insufflator. Failure to do so could necessitate configuring a laparoscopy cart in the future and reintroduce the inefficiencies the boom was designed to overcome.
• What are your current and future image and equipment management requirements? Your current mode of operation may not be on the high-tech digital fringe, but as technologies advance, what is today's digital frontier is tomorrow's standard of care. The boom's expected useful life is three to four times the expected useful life of most OR electronics. A boom will have successive generations of equipment parked on its shelves. And as the equipment becomes more feature-rich, the boom will need to support these features with available connectivity. What this means for evaluating booms is available cable space and ease of access to pull additional cables later. Granted, it may all be wireless in the future, but you have to plan for deliverable technologies today. On a construction-related note, these cables must have pathways above the ceiling and down the walls, and this means conduit. Close coordination is needed between your endoscopic equipment vendor and your boom vendor to ensure you plan correctly to accommodate present and future needs.

Other factors to consider
After you've addressed these four big-picture questions, you'll want to consider the following feature-related items, among others.

• Smoke evacuation. Do you want to order the boom with smoke evacuation - or at least with the ability to add it later? We all know about the dangers associated with surgical smoke plumes created by lasers and electrocautery. The Occupational Safety and Health Administration is expected to soon require protection of the surgical environment from all surgical smoke plumes.
• Number of outlets. You'll want to know how many electrical and gas outlets the boom will accommodate. Keep in mind that even for devices that aren't physically on the boom, your staff will still use the boom's electrical outlets to avoid the spaghetti factor. The biggest additional medical gas-service demanded on booms is vacuum for use inside and outside the surgical field. Orthopedic cases use vacuum for things like floor water collectors and cement-fume evacuation.
• Location of outlets. Where are the electrical and gas outlets located on the boom? There should be enough receptacles on the shelf side of the boom to plug in the devices on the shelves - this goes for power, video and data outlets. Conversely, there should be outlets on the backside of the boom convenient for use with other outboard equipment.
• Adjustable shelves. How easily are the shelves adjusted on the boom? Since the boom holds technologies that change rapidly, you'll likely need to adjust the shelves for new "boxes." It shouldn't be a huge ordeal or take a service call to the manufacturer to reconfigure the shelves. Also, after working with the boom for a while, the staff may want to rearrange the equipment to better suit how they work.
• Accessories. What accessories are available for the boom? Accessories make the outfit. How effectively you use your boom might depend on the capabilities for configuring it for your special needs. Accessories can be advanced features like smoke evacuation or laptop computer arms and more mundane items like drawers, baskets, IV poles, cable sleeves to tidy up its appearance (and cleanability) and rubber bumpers.
• Reach. What's the boom's reach? Also, if vertically adjustable, what's that range of motion? Booms should be sized to the room and the function for which they're tasked. A boom that has too much reach will seem to take up too much room (a visual phenomenon architects call scale.) A boom that doesn't have enough reach will introduce a new set of problems and probably won't be used effectively.
• Rotation. What's the boom's rotation at each articulation? Booms have varying degrees of lateral range of motion. Make sure the boom you select has enough range to allow positioning to meet all your anticipated needs. Also consider how easily the rotational stops are adjusted on the boom. After working with a newly installed boom, the staff may want the manufacturer, or their own biomeds, to adjust the limits on the boom's range of motion to keep it from traveling where it's not welcome - like into a wall or anesthesia machine.
• Maneuverability. How easily is the boom maneuvered? One argument in favor of booms is the ergonomic efficiency when compared to pushing carts in and out of the room. This benefit is negated if the boom is as hard or harder to manipulate than a cart.
• Movement. Where are the handles and brake controls for the boom? In order to be easily moved, the handles and brake controls should be easily accessible.
• Brakes. How do the brakes work? Some booms' brakes are actuated by compressed air, which can't be legally drawn from the medical air system. It needs its own compressed air source. Other booms have electric brakes. Both types have their advantages and disadvantages, but if retrofitting a room and you need compressed "shop" air, it will involve getting a compressor and plumbing to get the air to the boom.
• Cleaning. How easily is the boom cleaned? Look closely at how the boom is constructed and determine if it can be easily cleaned. Some booms' cover panels and shelf hardware have many exposed edges and crevices just waiting to catch dust and debris.
• Service. What is the available service for the boom in your locale? Many facilities standardize on a single vendor for booms and OR lights. This provides a single point of coordination before the installation, the ability to bundle both the boom and light purchase for a greater discount, and a single point of contact for service related issues.

Future is now
Technological advancements in minimally invasive surgery continue to change the approach outpatient surgery center designers, owners and operators take when equipping surgical suites. The most notable change in modern operating rooms is the move toward centralized control of the surgical environment by digital equipment and image management systems. These new-technology ORs have been touted as ORs of the future. But due to rapid adoption of these systems, the future is now.