The head butler with design modification: a useful mountable shelf for the operating table in robotic surgery

The ‘head butler’ or ‘iron maiden’, as it is sometimes referred to, is a mountable shelf that is attached to the main operating room table using stirrup clamps or brackets. It provides an elevated flat surface, which protects the patient’s face and chest from inadvertent trauma of robotic arms, instruments and camera while also serving as a platform for placement of instrumentation that minimizes handoffs to improve workflow. Its canted design also prevents slippage of instruments off the operating field during steep Trendelenburg positioning. This operating room equipment was designed to improve efficiency in an operating room set-up while ensuring safety during patient positioning when performing robotic procedures. A modification of the original Head Butler^® (Tri-Medical Corporation, Portland, OR, USA) is presented here which improves upon the design by avoiding brachial plexus nerve injury to the patient due to pressure from the uprights pressing on the patient’s shoulders during use.