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New technical solution to minimise noise exposure for surgical staff: the ‘silent operating theatre optimisation system’
  1. Martin G Friedrich1,
  2. Margarete Boos2,
  3. Manuela Pagel2,
  4. Tobias Thormann3,
  5. Adel Berakdar1,
  6. Sebastian Russo3,
  7. Theodor Tirilomis1
  1. 1Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, D 37075 Göttingen, Germany, Robert-Koch-Str. 40
  2. 2Department of Social and Communication Psychology, University of Göttingen, Georg-Elias-Müller-Institute of Psychology, Göttingen, Germany
  3. 3Department of Anaesthesiology, Intensive Care and Rescue Medicine, University Medical Center Göttingen, Göttingen, Germany
  1. Correspondence to Martin G Friedrich, Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, 4037075 Goettingen, Robert-Koch-Str. 40, Germany; m.friedrich{at}


The increasing number of technical equipment in the operating room (OR) is resulting in significantly higher noise levels. The more complex and sophisticated the surgical procedure is, the more essential it is for all team members of the OR to work together in a harmonious fashion to process and manage their demanding team tasks. With increasing noise in OR, the risk of more frequent errors also increases. The reduction of noise production in the OR is possible but limited. The aim of this study was to develop a device that reduces ambient noise for the operating team without hindering their ability to communicate.

We developed a new communication technology set-up for the OR to meet all needed requirements. All members of the operating team are issued headsets with microphones. The headsets filter out background noises (active and passive noise cancelling) and the microphones enable interactive communication among and between OR subgroups through targeted information selection (signal selection). Any remaining background noise is overshadowed by music, which is quiesced by direct speech into the microphone (ducking). Information flow is programmed on a digital workstation, providing each team member a selection of acoustic signals from the OR on their bidirectional headset. A complex matrix of connections in this audio technology allows a predefined communication structure. These procedures were assembled in the Silent Operating Theatre Optimisation System (SOTOS). The technical specifications and user interface are described. A pilot study in 2015 using the SOTOS in cardiac surgery showed very positive feedback from the participating operating team members. Further studies focusing on communicational psychology perspective and physiological reaction are recommended.

  • human engineering
  • operating room
  • operative outcome assessment
  • communication
  • noise exposure
  • surgical staff

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  • Contributors MGF is the corresponding author responsible for the concept/design of SOTOS and the drafting of this report. SR and TT are equal contributing senior authors. MB functioned as the topic expert advisor regarding both the report’s content and format. MP, TT and AB all provided support for the report’s data analysis/interpretation and statistics.

  • Competing interests MGF is the inventor of the SOTOS and all included features. The SOTOS is patented and the patent holder is the University Medical Center Göttingen (DE102015205463, PCT/EP2016/056659).

  • Ethics approval Ethikkommission der Universität Göttingen (No. 12/12/14).

  • Provenance and peer review Not commissioned; externally peer reviewed.