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Hybrid Operating Room Now State-of-the-Art; Radiology Meets Surgery

Posted Jan 08 2014 12:00am

I had not previously encountered the term hybrid operating room before I came across a recent article  (see: Gift to University of Michigan supports creation of a new hybrid operating room ). Here are some of the details:

A $7.5 million gift to the University of Michigan will advance research and discovery toward curing aortic disease, and support creation of a new hybrid operating room at the U-M Frankel Cardiovascular Center....The latest advancements in cardiovascular treatment include hybrid procedures in which catheter-based interventions, simultaneous imaging and open chest surgeries are performed in the same operating room. The newest hybrid surgical suite, which is double the size of a regular OR, is the third for the U-M and merges the radiological and surgical techniques that make advanced hybrid procedures possible.....Patients, especially the elderly, recover quicker from less invasive procedures....“Technology is changing how we think about and treat health problems,” says cardiac surgeon G. Michael Deeb, M.D.....“For example if we have a patient with a large aneurysm and cardiovascular disease, we would like to treat those problems simultaneously in order to decrease time on the heart-lung machine. In a hybrid operating room we can perform angioplasty and stent the lesion via transcatheter techniques and then proceed with the open surgery.” 

Here's more information about hybrid operating rooms from the Wikipedia (see: Hybrid operating room ):

A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. These imaging devices enable minimally-invasive surgery, that is less traumatic for the patient. 

Here's a definition for fixed C-arms (see: U.S. Market for Fixed C-arms to Grow More Than 5% Annually Over Next Five Years ):

Fixed C-arms are X-ray systems used in complex angiography, cardiology, and neuroradiology procedures....Fixed C-arm systems are used to guide surgeons performing interventional procedures. Modern flat-panel detector systems provide surgeons with superior image quality when performing complex, time-sensitive procedures.

Here's more information from another article about hybrid operating rooms (see: Two in one: Planning a hybrid operating room ):

...[H]ybrid ORs are often the preferred surgical suite configuration among surgeons. In fact, of 335 cardiac surgeons surveyed in 2009 by Steris Corp., 75 percent said they would like a hybrid suite in their hospital. Having a hybrid OR is becoming a standard requirement for leading new and renovated hospitals also because they can serve dual functions.....You can use them as a combined cardiovascular and surgical suite or else swing all the specialized imaging equipment aside and use it as a general operating room.

[I]it's a new breed where the orchestration of teams, workflow, protocols, equipment and space present a new set of challenges. Additionally, the melding of the two distinct functions of radiology and surgery into one OR presents a new mix of physical requirements. For example the sterile and highly flexible environment of a surgical suite must accommodate the large footprints, considerable weight and rigorous stability specifications of radiology lab equipment. Connectivity is also an issue impacting the technological infrastructure. Will the surgical team use the OR to consult with medical staff on site or remotely? Will video feeds from hybrid OR procedures be transmitted to teaching or meeting rooms?

As I was writing this note, a couple of ideas occurred to me. First of all, these new types of ORs are obviously incredibly expensive. Refer to the reference above about funding with a gift of $7.5M. This new technology obviously increases the cost of care and creates an even larger separation between smaller hospitals and the well-endowed larger ones. My other thought is that we are about to enter an era when the concept of "open surgery" will be unknown to medical students. Why would one want to make a large incision in the abdomen when you can approach an organ intravascularly or with a keyhole incision?

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