Hybrid operating theatres

What defines them, how do they affect surgeons’ work and what is their value to hospitals? Christian Tebel, head of Professional Services at TRUMPF Medical Systems, explains

Basically, a hybrid operating theatre (OT) is a combined operating room containing large imaging equipment, such as MRT and CT, which enables intra-operative diagnostics. If provided for in the hygiene and theatre concept, the hybrid OT can also be used purely as a diagnostics room, or as a classic operating room.

Christian Tebel is responsible at Trumpf for planning and conducting...
Christian Tebel is responsible at Trumpf for planning and conducting international product and application training, global analysis of medical trends in operating theatres and ICUs, and advising clients and employees on matters related to medical applications and clinical concepts (Photo: Trumpf Group)

Likewise, operating theatres with integrated in-patient or mobile angiography devices are also called hybrid OTs. Simply imagine an operating room with a completely equipped cardiac catheter laboratory.

This definition of a hybrid OT has gained increasing acceptance because more and more cardiologists and vascular surgeons employ hybrid procedures. Specifically, this means that interventional treatment by means of a vascular catheter, for example, is combined with open surgery.

A hybrid OT enables a multitude of new surgical procedures – for virtually all disciplines. New potential areas of application are emerging especially in trauma and orthopaedic surgery, neurosurgery, cardiac and vascular surgery. For example, the trend in vascular surgery is shifting increasingly from open surgery to endovascular procedures, and also open and interventional therapies are combined. This is feasible in a hybrid OT. Even if open surgery is indicated for endovascular or minimally invasive surgery (MIS) in an emergency, this is possible in one time-saving session involving less risk and strain for the patient. Another example, from the field of neurosurgery: in this case intra-operative imaging serves to update preoperative image and navigation data. This results in key advantages with respect to perioperative delimitation of tumour tissue and determination of resection borders

Costs

Purchasing large devices, such as MRTs, CTs or angiography equipment, is always a big investment. So it’s all the more important to use such equipment as economically as possible. If this is done in a hybrid OT, both human and technical resources can be utilised optimally. Integration of a hybrid OT into the central surgical department generates the most advantages. In particular because a hybrid OT permits interdisciplinary applications and is thus available to the theatre management as an operating room resource. In short, once the hybrid is set up, the clinic can save enormous costs through its use and additionally optimise the selection and quality of treatment methods. This also increases patient and staff satisfaction.

Prerequisites for interdisciplinary use

Key factors include the right room design and an appropriate selection of technical equipment. At the same time the imaging device and operating table must form an integral unit. Planning therefore plays a crucial role, since both the room concept and the technical equipment have to be adapted to the respective in-house procedures and concepts. As for choosing the right operating table system, an interchangeable table top system with a fixed column offers the greatest scope. It ensures that a defined reference point is provided in the room for the imaging devices. Moreover, you can take advantage of the entire spectrum of operating and diagnostic table tops. That’s the basis for interdisciplinary use.

An example of an X-ray system suitable for interdisciplinary use in a hybrid theatre is the Siemens Artis Zeego. The C-arm and an exclusively developed version of the Trumpf operating table system TruSystem 7500 work together ‘as a team’, meaning both devices know where the other is positioned. That’s the basis for integrated collision protection. Furthermore, the C-arm and the operating table can be controlled via a joint control platform if necessary.

Installation is not exactly easy. When you equip an interdisciplinary hybrid OT with a CT or MRT, you must first keep the room concept in mind. Nowadays multi-room concepts are also implemented. In this case the large equipment is mobile and can be used alternately in two or even three rooms. No matter whether it involves a CT, MRT or devices like Artis Zeego, in every case there are additional requirements regarding room size as well as control and technical rooms. This is easier to accomplish during the early planning phase for new buildings. If you subsequently install equipment in hybrid OTs, things become more difficult. Frequently, however, adjoining rooms are available for the respective use in central OT units. If they are ‘rededicated’, and operating theatre logistics, procedures and the OT concept are optimised simultaneously, you kill two birds with one stone.

The factors that guarantee smooth incorporation of an interdisciplinary hybrid OT into a central OT unit include precise planning and prompt integration of the users in order to boost acceptance of interdisciplinary use. I mean, not only does the equipment work as a team in the hybrid OT, but also different and, from a historical viewpoint, ‘non-OR-related’ disciplines must function as a team in the hybrid OT. The same applies to the companies whose medical technology products are to work together in the hybrid OT.

I believe hybrid OTs are the future. Classic open OT procedures are reducing, so it’s necessary to integrate imaging into the operating theatre. Disciplines of internal medicine, with their interventional and endoscopic procedures, increasingly work hand in hand with surgical disciplines, with their open and minimally invasive methods. Even radiology cannot avoid this trend towards integration. Specialised departments are increasingly joining forces. Industry must also accept this development. The hybrid OT is one of the main drivers of this development. No supplier can cope with the complexity of the hybrid OT alone; teamwork is called for.

Trends always involve hurdles. Mostly they naturally relate to available budgets. Another factor in the case of hybrid OTs is that an understanding regarding optimum exploitation of resources must grow and even greater focus must be placed on the importance of cooperation between clinics, planners and industry. If we succeed in overcoming these hurdles, the realisation of hybrid OTs will become more than just a trend!

19.05.2010

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