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FROM THE VAULT: Hybrid Operating Room (2010)

FROM THE VAULT: Hybrid Operating Room (2010)

Hybrid Operating Room

It all comes down to improved visualization. If, for instance, you need your aorta repaired, the improved visualization that high tech imaging provides can mean the difference between open heart surgery through a large incision in your chest and, minimally invasive surgery through a tiny incision in your side.

Combine improved visualization with the most sophisticated surgical equipment available and you have a hybrid operating room. Integrating state-of-the-art digital imaging technology with traditional as well as leading edge minimally invasive surgical equipment, a hybrid operating room has it all.

Visualize this - multiple surgeons each from a different discipline, working together, on the same patient, at the same time, to perform a complex surgery that would otherwise require several separate trips to the operating room. If during the surgery, a change in approach is needed - from minimally invasive to open surgery, for instance - it is easily accommodated. In a traditional operating room setting, that patient would more likely need to be stitched up and rescheduled for another surgical procedure, on another day.

At the Guthrie Clinic in Sayre, PA their new Hybrid Endovascular/Cardiac Operating Room Suite was a dream in the making for over two years. At 1,200 square feet, it bears almost no resemblance to a traditional operating room. There are large high definition LCD screens mounted from the ceiling around the room, as well as a 46" plasma screen. A large imaging machine is also mounted on the ceiling and is capable of gliding over the operating table. It is flexible enough to be positioned wherever needed, as needed, during surgery.

The flexibility of high resolution digital imaging equipment in the hybrid operating room make it possible for surgeons to see clear, accurate "real time" images of the patient's internal anatomy, including small blood vessels, from any vantage point, without a direct view of the inside of their body. Those images are then used to help surgeons guide tools such as stents, catheters and guide wires during minimally invasive procedures.

Radiology technologists staff a control room just outside the operating room and assist in obtaining any images needed during surgery. Angiography, CT scans, and 3D image reconstruction are all available at a moment's notice in the hybrid operating room.

"The room is a tool. It is the experience and the skill of the team that makes a difference," says Robert Larson, MD, Chief of Vascular Surgery for Guthrie. Guthrie's team includes highly trained nurses of many different disciplines, radiology technicians, anesthesiologists, interventional radiologists, vascular surgeons, and cardiac surgeons to name just a few.

Open since late May, Guthrie's Hybrid OR Suite already stays very busy. "This hybrid operating room represents a quantum leap forward in the cardiovascular care we can offer patients in our region," explains Dr. Larson. "It's unique in our area and we are fortunate to have a facility like this, outfitted with brand new state-of-the art equipment, considering our relatively rural setting."

That equipment, he says, will not soon be outdated either. "The technology behind the hardware we use for imaging has reached its peak," Dr. Larson explains. "The equipment we have now will remain leading edge for 10 or 15 years into the future. The software will continue to improve, but that is easily updated."

For Guthrie, the $2.7 million investment is easily offset by the significant benefits it offers patients. Shorter hospital stays, less time in intensive care units, fewer complications, less pain, and a reduced risk of infection are just a few of the advantages leading to better outcomes. The collaborative environment and sophisticated equipment also creates new surgical capabilities.

"You can only work as well as you can see and until now, the quality of imaging was a limiting factor," says Dr. Larson. "Now we can perform procedures that we might have otherwise been hesitant to perform."

Before the hybrid operating room, doctors sometimes used portable equipment in operating rooms where complex endovascular procedures were being performed. That equipment had its limitations, however and often could not provide adequate images of every patient.

"The portable equipment may have been fine for use on a petite woman, but it didn't allow us to see into the chest of a large male patient," said Dr. Larson.
Another issue resolved by the hybrid operating room is that patients no longer need to be taken out of the sterile environment, to another location in the hospital, for specific imaging studies that are sometimes needed during surgery. This reduces the risk of infection for the patient, minimizes procedure time, and eliminates the need for sedating patients multiple times or for longer periods of time.

As a Level II Regional Trauma Center, Guthrie has already seen the benefits of the hybrid operating room suite in emergency cases. Trauma protocols have been developed and adapted to take full advantage of the new technologies and equipment available.

"Recently we used the hybrid OR to perform emergency surgery on a 37-year-old man who was involved in a motorcycle accident," says Dr. Larson. "He had an aortic rupture that we were able to repair through a small incision in his side. The repair went well, the patient had little pain, and was able to go home within a couple of days, versus what might have been weeks with open surgery."

Shorter recovery periods, less pain, and the ability to undergo multiple procedures at one time are all big advantages of the hybrid operating room that patients appreciate. Convenience, though not as important as having life saving treatments readily available, is also an advantage for local families. The availability of leading edge cardiovascular care at Guthrie means eliminating the need to travel out of town for complex procedures.

But ultimately, it comes down to saving lives, healing disease, and giving someone back quality of life - as quickly and painlessly as possible. Hybrid operating rooms and the health care professionals who staff them are ready to do just that.

Robert Larson, MD
Chief of Vascular Surgery
Guthrie Clinic
Sayre, PA

By: Lisa M. Mayers