Hybrid Operating Rooms Put the Focus on the Patient

Philipp Grätzel von Grätz |  2018-07-23

Patient-centered care? This is not just a slogan when it comes to surgery in hybrid operating rooms. Good planning and active interdisciplinary cooperation ensure that modern operating theaters, which combine diagnostics and therapy, can be a hospital’s success story.

Photos: Markus Zucker

Hybrid operating rooms (OR) are digitally integrated theaters that combine diagnostic imaging with surgical and interventional therapy in a single room. Unlike conventional operating theaters, where a mobile C-arm is occasionally used for intraoperative imaging, CT or MRI systems are an integral part of the hybrid OR. This ensures that the patient receives optimal care without repositioning.
 

Numerous advantages

“For me, the hybrid OP is a prime example of an innovation that really puts the patient at the center,” said Alfred Holzgreve, Director of Clinical Research at the Vivantes Network Berlin, at a symposium in Germany’s capital entitled “Hybrid OR: convergence of diagnostics and therapy". He discussed applications of the hybrid OR as well as optimal strategies for setting up these operating theaters with surgeons as well as specialists from hospital administration and industry.
From a medical perspective, one of the advantages of the hybrid OR is that it noticeably streamlines many perioperative and peri-interventional procedures, Holzgreve stressed. Hence, the patient does not need to be repositioned or shifted back and forth as much. Compared to working with a mobile C-arm, the procedures are quicker, meaning the patient benefits not least from spending less time under anesthesia. Preoperative diagnosis is also quicker. What is more, the hybrid OR allows the surgeon a greater degree of precision, stressed Josef Rosenbauer, Managing Director of Diakonie South Westphalia gGmbH: “This means we don't have to carry out follow-up procedures and thus can improve patient safety.”

Everything in one place

Many hospitals perform procedures today that they would not have done with mobile C-arms alone. These include fenestrated and branched stent graft implants in the abdominal and thoracic arteries which, especially in the area of the aortic arch, would be scarcely conceivable without the hybrid OR. The hybrid OR is also ideal for complex vascular procedures on the lower leg, where surgery and interventional therapy go hand in hand, he said.
Generally speaking, the hybrid OR plays to its strengths when it comes to closely combining diagnosis and therapy. Interventional stroke treatment was mentioned as a particularly striking example of this. Here, the hybrid OR enables vascular diagnostics and interventional thrombectomy to be performed in one room without the need to relocate the patient. “In this way, the time between a patient's arrival and the thrombectomy could be reduced from 60 to 15 minutes,” said Peter Seitz, Global Head of Surgery of the Business Area Advanced Therapies at Siemens Healthineers AG.

Good planning is everything

For all its advantages: A hybrid OR does not, however, make sense in every hospital. If the room cannot be used to capacity for the procedures it is best suited for, funds may well be better invested elsewhere. An important part of any hybrid OR planning should therefore be coordination with all relevant specialized fields. “It is difficult to utilize a hybrid OR to capacity with just one specialization. So there needs to be an analysis of the specialization structures first,” Rosenbauer said. At the Diakonie hospital in Siegen, neuro, trauma, and spinal surgeons use the hybrid OR alongside vascular surgeons. Together these specializations may soon utilize two hybrid ORs to capacity: a second operating theater has been equipped to serve as a hybrid OR.

“You have to have doctors who can perform the operations made possible by hybrid surgery.” Josef Rosenbauer, Managing Director, Diakonie South Westphalia gGmbH, Siegen, Germany

In addition to the specialization structure, a hospital considering acquiring a hybrid operating room should give careful consideration to the catchment area, the competing facilities, and last but not least, the staffing situation, Rosenbauer stressed. “You have to have doctors who can perform the operations made possible by hybrid surgery,” he said. “These doctors cannot be found everywhere, and even surgical nurses with the relevant skills may not be easy to find.” Siegen brought in a completely new OR team for vascular surgery. There were already qualified staff on hand for neuro, trauma, and spine surgery.

Augmented reality and artificial intelligence

Peter Seitz also confirmed that hybrid surgery is becoming multidisciplinary: “In our new generation hybrid ORs more than 80 percent of the rooms worldwide are being used in a multidisciplinary way.” Siemens Healthineers has already equipped more than 1,000 hybrid ORs around the world, around ten percent of them in Germany. Seitz stressed that hybrid operating rooms have developed rapidly since their introduction. “The diagnostic possibilities are coming progressively closer to the normal diagnostic capabilities in radiology. Our systems now make 3D imaging possible within a few seconds,” he said.
The use of hybrid ORs with other diagnostic modalities, particularly MRI, has increased in recent years. “For institutions that, for example, want to develop new procedures, this can make a lot of sense,” said Seitz. He cited liver ablation as an example of a combined use scenario, where CT can be used to guide the needle and the temperature can be controlled during cryoablation using MRT.

“If we know exactly where the tumor is before the incision, there are fewer complications – there's no doubt about that at all.” Alfred Holzgreve, Director of Clinical Research, Vivantes Network Berlin, Germany

The use of augmented reality (AR) techniques and self-learning algorithms that support the surgeon in real time during the operation are among the future scenarios for hybrid ORs. Seitz outlined a combination of an intraoperative 3D camera and data glasses that use preoperative 3D datasets to project onto the operation site a kind of avatar of the organ, tumor, or blood vessel to be operated on. From the point of view of the surgeon, such developments are to be welcomed, said Holzgreve: “If we know exactly where the tumor is before the incision, there are fewer complications – there's no doubt about that at all.”


About the Author

Philipp Grätzel von Grätz works as a freelance journalist specialized in medicine, healthcare, and technology in Berlin.
 


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The statements by Siemens Healthineers customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.