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How the right-sizing of hybrid operating rooms helps hospitals, surgeons, and patients

October 23, 2018

Advancing technology is moving OR imaging equipment from fixed and cumbersome to smaller and mobile

Co-authored by Gregory T. Mick

Successful procedures in the operating room need a surgical team with seamless coordination—an effort made more complex in a hybrid operating room. A hybrid OR is a surgical theater that is equipped with advanced medical imaging devices allowing a large team of surgeons, interventionalists, nurses, anesthesiologists, and technicians to “see” inside the patient before, during, and after using a scalpel to incise. In addition to internal snapshots, the team can also see the anatomy “in motion.”

Hospitals of all sizes are increasingly embracing the inclusion of hybrid ORs in their surgical suite. These rooms and associated imaging devices are becoming a standard element and are no longer considered as only belonging to academic medical centers or specialty hospitals.

On the gantry of the Discovery, the only fixed connection is an overhead tether. The full unit is mobile and can be programmed to be parked out of the way. Shown: Discovery IGS-740, courtesy of GE.

Hybrid ORs come with the expectations that surgeries can be less invasive. Having the ability to see inside, allows procedures to be completed with smaller incisions, more precision, and higher confidence that desired surgical outcomes were achieved before closing the patient.

This exciting new modality did not come without a cost—literally. Hospitals needed to increase the size of their operating rooms to accommodate the large associated imaging equipment. Standard 400-square-foot ORs were now being expanded, sometimes up to 800 square feet or more, to ensure there was adequate space for both the surgical and imaging functions. Not only were healthcare administrators facing costs for OR renovations to create the new hybrid rooms, but they were also experiencing decreased utilization. With such large equipment fixed in the operating rooms, many hybrid rooms were sitting idle until needed for specialized surgeries. Simpler surgery cases in these rooms were awkward to conduct when the team was constantly elbowing the hulking imaging devices not easily sequestered to a corner or edge of the room. Therefore, these hybrid rooms would often sit empty.

Smaller, transportable equipment not only saves money by avoiding room expansion and lowering renovation costs, but it allows for greater utilization.

Although hospital administrators, surgeons, and technicians were excited about this new path for patient care, the associated cost—space, time, and initial equipment purchases—were dampening that enthusiasm. But as it often does, advancing technology was about to change the game.

We are just beginning to see the next generation of equipment emerging that is smaller in footprint—and more mobile—allowing the imaging equipment to “park” in a minimized/remote corner of the operating room. No fixed mounting point on the floor or rails in the ceiling that limit the location options and range of motion for the devices as in the recent past. One device doing this is the Discovery IGS series by GE. It is connected via umbilical to a point in the ceiling of the operating room and can be brought close to the patient when needed. It can then “park itself” in a convenient corner of the room using internal GPS tracking to maintain both location awareness relative to fixed objects and to the patient anatomy position for sequential image acquisition needs during various periods of the procedure.

This hybrid OR is fit with a floor-mounted gantry and ceiling-mounted C-Arm, which can crowd patient table access for non-hybrid cases. Both pieces of equipment are connected to the building structure, which limits how remote they can be stowed when not in use.

With imaging equipment becoming more manageable—in size and flexibility—in the operating room, important benefits of a hybrid space are being realized. No longer do hospitals need to spend valuable dollars expanding the square footage of their ORs to accommodate for imaging. The new equipment can be easily accommodated in a more standard-size operating room. Now that this equipment can be repositioned, imaging machines can be easily moved to the corner of the room when not needed and rolled back in to action when required.

Smaller, transportable equipment not only saves money by avoiding the need for room expansion but reduces renovation costs and allows for greater utilization. Hybrid ORs can offer more flexibility and be used for all types of surgeries because the medical staff now has the room to perform procedures that don’t require interoperative imaging.

However, there is some investment needed to ensure the movable imaging equipment performs with the intricate accuracy required for precise procedures. Previously, equipment installation costs were focused on the structural implications of suspending weighty elements from the ceiling while facilitating movement and pivoting, or on potential structural reinforcement of the floor to support the point loads of cantilevered rotating image intensifiers. With the new tethered versions, it is now critical to have a completely smooth and level floor surface to ensure that the movable device is free rolling without vibration or irregularities aiding in calibration accuracy.

It is encouraging to see the evolution of medical devices supporting interoperative imaging moving toward smaller, free-moving configurations. Perhaps many hospitals, previously faced with space restrictions, can now consider adding hybrid OR environments in their facilities with less invasive construction/renovation solutions and without concern that highly specialized equipment will preclude flexible room utilization. Are we, as healthcare architects, finally seeing the right-sizing of hybrid ORs? It seems that the next generation of interoperative imaging tools will let us move in that direction.

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