HYBRID OPERATING ROOM

A hybrid operating room is where major procedures that combines a conventional surgical and interventional procedure guided by fluoroscopic or MRI imaging in a hybrid room without interruption.

Traditional fixed C-arms produce 2D fluoroscopy or 3D rotational angiography but with the advanced technology nowadays, C-arms are able to acquire CT-like 3D images and used for image guided surgery and also in intra-operative imaging like flow analysis. With these newer fluoroscopic C-arms where the device image intensifiers are of the digital flat panel detectors has thus enabled the fluoroscopy techniques to transit into three dimensional CT-like imaging capability.

Hybrid operating rooms are currently used mainly in cardiac, vascular and neurosurgery, but could be suitable for a number of other surgical disciplines.

PLANNING THE HYBRID ROOM

Before planning a hybrid operating room, a clear vision of the utilization should be established. It should address the requirements and the needs of various surgical specialties, procedures and workflow. To ensure a smooth workflow in the room, all parties working together should state their needs and requirements, which will impact the room design and determining various resources like space, medical, and imaging equipment. This may require professional project management and several iterations in the planning process with the vendor of the imaging system, as technical interdependencies are complex. The result is always an one solution tailored to the needs and preferences of the interdisciplinary team and the hospital.

Reference: hybridoperatingroom.com

LIGHTS, MONITORS AND OTHER DEVICES

Multiple movable and flexible booms need to be installed in the OR. If there are 2 booms to be installed, a boom of every side of the operating table should be considered to serve the operating team. Collision of the ceiling mounted display with the surgical lights or other ceiling mounted devices should be avoided. Large displays are now available and capable of integrating multiple video inputs on various sizes and therefore decreasing the needs for multiple screens. A dedicated ceiling plan with all ceiling-mounted components including air conditioning should be drawn to ensure the function and usability of all devices. 

The hybrid OR facilitates a whole new spectrum of cardiac surgical therapies, and will therefore become an essential resource of every cardiovascular centre. The trend towards hybrid OR is more of a revolution than an evolution due to the rapid integration into the surgical techniques. The hybrid OR itself represents an extreme complex working environment that demands careful planning by all stakeholders. Bundling all clinical, technical and architectural expertise as well as a realistic view of what is achievable is key for a successful hybrid OR project. 

Reference: cardenjennings.metapress.com & hybridoperatingroom.com & www.maquet-hybridoperatingroom