Transactions on Machine Design Fatima TAIF, Abedelwahed NAMIR, Mohamed AZOUAZI 14 1 2026 https://doi.org/10.6025/tmd/2026/14/1/10-22 https://www.dline.info/tmd/fulltext/v14n1/tmdv14n1_2.pdf This work presents a multidisciplinary framework for modeling and managing operating theatre (OT) systems through a multi-agent system (MAS) integrated into an Interactive Decision Support System (IDSS). Recognizing OTs as critical bottlenecks in hospital workflows, the authors address the challenge of frequent schedule disruptions particularly from emergency cases by proposing a real-time, adaptive rescheduling architecture. The system features supervisor agents for global coordination and service agents representing operational units (e.g., operating rooms, surgical teams). These cognitive agents negotiate, prioritize, and allocate resources dynamically using algorithms for resource allocation, unavailability handling, and information retrieval. Decision making is enhanced by the ELECTRE III multi-criteria outranking method, which resolves conflicts based on clinical urgency and resource availability. Implemented in JADE, the platform uses FIPA standards to ensure robust, interoperable agent communication. Beyond software coordination, the paper also outlines key principles for OT equipment design including ergonomics, sterility, modularity, safety, and interoperability and emphasizes human centered design, regulatory compliance (e.g., ISO 13485, IEC 60601), and sustainability. Emerging trends such as AI, IoT, and digital twins are noted as enablers of smart, resilient operating theatres. The approach aims to optimize resource utilization, reduce delays, and improve res ponsiveness in high pressure surgical environments, filling a gap left by prior domain specific MAS application that overlook emergency surgical coordination.