Operating room technology
While some hybrid ORs use multiple screens, the one in Albertinen uses Siemens’ Artis zeego, with its single large screen. Lars Kock, head of the department for vascular and endovascular surgery, explains: “The screen has different areas showing the live image, the recorded image and the vital parameters for heart frequency or blood pressure, so we have everything that we need to know while we are operating on this large display.” Increasingly, hybrid ORs are also equipped with MRI or CT scanners to guide complex procedures such as brain surgery. Cardiac surgeons are now carrying out far fewer open operations, especially on the aorta, says Kock, because they are “big operations with high risks”. As the population ages, demand for endovascular interventions will increase. “For many of our patients, who are mostly elderly, it’s a great benefit that we can treat them with endovascular techniques, because they have far less risk than the open operations,” says Kock. Although it’s possible to perform endovascular procedures in a standard OR with an ordinary C-arm, the image is of lower quality and the radiation dose higher, he adds. The hybrid OR is “the gold standard” for endovascular procedures: “If you are used to it, as we have been for seven years, it’s hard to think how you can provide good treatment to patients without these techniques.”
Obstacles to uptake
Although hybrid ORs are not a new phenomenon – in the UK, the first one was opened in Liverpool Heart and Chest Hospital in 2007 – adoption is increasing rapidly, with one study predicting a compound annual growth rate (CAGR) of 12% between now and 2030. The main driver has been near-universal acceptance of the value of minimally invasive surgery. While its merits were hotly debated 20 or 30 years ago, says Mark Slack, chief medical officer and co-founder of CMR Surgical, the debate has now
Practical Patient Care /
www.practical-patient-care.com
been won conclusively. “You reduce complications by 50% by doing keyhole,” he says, explaining that it also results in fewer infections, fewer hernias and a lower risk of opiate dependency. Hospital stays are typically shorter. Currently, wound infections from open surgery cost the US healthcare system an estimated $3.5bn to $10bn per year. The widespread adoption of minimally invasive techniques would slash that cost significantly. As Slack says: “If you have a keyhole surgery scar, nobody goes back to hospital and nobody goes back to theatre, because you can treat it as an outpatient.”
So, if a hybrid OR enables surgeons to carry out minimally invasive surgery, and minimally invasive surgery provides unequivocal benefits to patients, then why not convert every OR to a hybrid? In practice, hospitals have good reasons for not taking such a bold step. Currently about half of the 12 million surgical procedures carried out in the UK annually are still performed under traditional open conditions – even though, in principle, most could be performed using minimally invasive techniques. The reason, as Slack points out, is that minimally invasive surgery is a highly specialised and difficult skill, performed by a minority of surgeons. It is also extremely demanding. Anthony Fernando, president and CEO of Asensus Surgical, notes that traditional laparoscopic surgical practices “take a toll on surgeons, both mentally and physically, with 87% experiencing performance-related symptoms, including musculoskeletal disorders”. While open surgery is still so prevalent, it makes no sense to convert all ORs to hybrid status. Hybrid ORs require far more space than traditional ORs because the C-arm and other equipment take up a lot of room. Albertinen’s hybrid OR, for example, is at least 100m2
in size. As Kock points out: “You
need a lot of space for all the products that you implant in patients – all the stents, balloon stent grafts, catheters.”
Asensus Surgical's Senhance system combines augmented intelligence, machine vision and deep learning to reduce surgical errors.
12% Expected
compound annual growth rate in the use of hybrid operating rooms between now and 2030.
Healthcare Intelligence Markets 45
Asensus Surgical
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