The French culinary term Mise en place means "everything in its place" and it simply means getting all the ingredients and utensils together before the cooking begins. Mise en place is also a practice that has many uses outside the kitchen … including the operating room.

Typically the OR will have a "back table" where a surgical assistant gathers all of the anticipated instruments and supplies for a specific operation which is stacked in trays and bins that must be sorted as the operation proceeds. Eisenhower Army Medical Center is one of very few hospitals in the country and the only one in MEDCOM that employs a cantilevered shelving system that allows the assistant to see all of the instruments at a single glance. There is also a touch-screen tablet that shows the operation step-by-step so the assistant can better anticipate the surgeon's needs.

According to the manufacturer's description, the specialty table has "additional room for large cases such as orthopedics … [the shelves] hold multiple trays and are angled for clear observation of instruments."

It is used "primarily orthopedic total joint and spine procedures," said Lt. Col. Thomas Rawlings, chief of EAMC's OR. While there are other back tables on the market, it's "the tiered aspect of the table that allows for visualization of multiple pans" that makes this special.

"[The manufacturer] showcased this table at the Association of Perioperative Registered Nurses Surgical Expo in Anaheim, California, in March," Rawlings said, "and I asked them to come [test] the table here … the only place I know of [in the United States] that it's in use is Mass General," as Massachusetts General Hospital in Boston is more commonly known.

The benefits accrue to through the surgical team to the patient. The design "improves efficiency [of the surgical assistant as well as the team] by being able to visualize all the sets of instrument, and not spending time unstacking and stacking sets like on traditional OR table," said Rawlings. "Plus the advantage of a video system is that it allows for visual cues on table set up and procedural steps."

The information on the touch-screen video is not patient specific but is specific to the particular procedure being performed, and it is customizable for each surgery and surgeon, according to Rawlings. Not only does the screen help the surgical assistant locate equipment but it also shows next step in the procedure so the assistant can be ready and anticipate what the surgeon will need next.

And, if a surgeon moves to a new hospital and that hospital has this back table system, the surgeon can move his programmed procedures with him.
The programming is especially helpful to new technicians, said Spc. Lauran Lovejoy, an orthopedic scrub technician.

"A new tech can simply click on the case, click on the surgeon and [the screen] shows the layout of all the instruments."

Lovejoy, who has been an ortho scrub tech for five years, is especially appreciative of the slanted shelves and the wide, flat work surface.

"I can see everything and not have to dig around looking for something," she said. "I can lay everything out and have it ready."

Because the assistant spends less time rooting around in bins and trays for the next tool, the surgery moves along much more smoothly, she said, and the patient is often not under anesthesia as long.

It's a simple, brilliant design that directly benefits all facets of an instrument-intensive, complicated surgery. And it's flavored by the adaptation of a French culinary technique.