Room together – hybrid operating theatres

For such a recent technological innovation, the hybrid operating room has quickly become a must-have concept for surgeons and hospitals around the world. According to research by the American Hospital Association, 75% of cardiovascular surgeons will be working in hybrid operating suites by 2018.

Anybody familiar with the technology won’t struggle to understand why. The same study cites an example involving the electrophysiology team at the University of Virginia Health System. In the case study, a patient was undergoing surgery to remove the lead of their pacemaker, which had become dangerously attached to the vein with scar tissue. During the minimally invasive procedure, the team reached a point where their catheter-guided laser was unable to cut through the wire. What could they do?

Under normal circumstances, the team would have to have stopped the procedure and invited another group into the operating room to commence open surgery but, taking advantage of the facets of a hybrid operating room meant, in this case, that this was avoided. Instead, they were able to call in an invasive radiology team from the floor below to ‘snare the catheter’ from another position.

Imaging equipment, from ultrasound to endoscopes, may have been used in operating rooms for years, but with complex, high-risk, minimally invasive surgical procedures such as the one the team carried out here, the benefits of having high-powered visualisation equipment are obvious.

“They were able to work it loose by the interventional radiology and electrophysiology teams pulling back and forth,” said Gregory Wozneak,the hospital’s administrative director of invasive cardiology, quoted in the study, “and they finally broke the lead free without any complications. It was an incredibly elegant level of teamwork.”

On top of advanced imaging equipment, hybrid operating rooms also offer the ability to transition from minimally invasive procedures to open surgery if the situation calls for it. This brings a number of major benefits, according to Arjen Radder, Philips Healthcare’s CEO for Turkey and the Middle East.

“Sometimes, during or as a result of these minimally invasive interventions, the doctor will conclude that surgical intervention is necessary,” he says. “In the past, when you had an issue with the clogging of your coronary arteries, for example, usually you had to go for a bypass and have a surgical operation to open your chest. The good thing about the hybrid lab is that you are basically able to offer different treatments to the same patient, at the same moment in time and in the same environment.

“You can imagine – when you are thinking about patient friendliness, about being able to follow a patient from one station to the next and about the cost of delivering that treatment – that doing something in one environment is a big advantage not only for the patient, but for the healthcare system and for those paying for that system as well.”

Open to the shift

On top of the specific trends driving the increase in hybrid operating rooms – increased use of minimally invasive surgery with patients wanting the benefits of faster recovery, more complex interventional imaging and physicians preferring the option of performing different combinations of surgery in the same location – there is, according to Radder, a wider, macroeconomic story that works in the favour of any healthcare product that offers cost-effective, patient-friendly and digitally orientated solutions to medical practitioners.

“Everyone sees the same picture,” he says. “People are ageing and moving from acute diseases to chronic diseases, while consumers are showing more concern for their health. There’s also a lot of pressure on the sustainability of current health systems in terms of payment. Can we afford to put so much of our GDP into healthcare?

“And, of course, we see that more people are starting to use digital, which is coming into healthcare and will help us industrialise the space. This means we need to try to offer the best possible care and drive the best possible outcomes for the lowest potential cost.”

Of course, in the Middle East, things are slightly different, Radder explains. “It’s obviously a relatively young population, but you see that the development of chronic diseases often happens faster,” he says. “If it’s a cardiovascular disease or an oncological disease, it moves faster than in other parts of the world.

“When it comes to digital, you also see that, with a fast-growing population, things moves much quicker – more so than in my home country in Europe. That is a very interesting difference that we need to cater for.”

So how does this affect the market for hybrid operating rooms, and are hospitals and governments Middle East embracing the technology?

“I think they are very receptive to new technology and very receptive to ways in which we can make the lives of patients easier,” Radder says. “This is certainly true when it comes to hybrid labs and combining different things in one physical environment.

“From my personal conversations in the Middle East, I can say that doctors and also administrators are interested in how they can combine new technology that is good for the patient and, at the same time, optimise their workflow so that they have the best possible outcomes at lower costs.

“That is a topic that everyone understands in the Middle East. Governments and people here are very determined. They have a track record of getting difficult things done, and that means you find an environment that is actually very willing to partner with companies like Phillips to make progress happen, which I find very enjoyable.

“Governments here have a good understanding of what innovative technologies can do and how high-quality care can be delivered.”

Ranged class

Philips’ own involvement in the Middle East hybrid operating room space involves a partnership with Maquet, a German multinational company based in Rastatt. According to a recent press release, the suite they have created “combines the sterility and instruments of a traditional operating room with X-ray and ultrasound imaging systems and the radiation shields of a cath lab”.

With a flexible X-ray system with a 20in field of view for minimally invasive cardiac surgery, a HeartNavigator that combines pre-procedure CT images of a patient’s cardiac anatomy into a 3D image and overlays it with live X-ray fluoroscopy information, a hybrid table system featuring a carbon fibre tabletop with 360° radio translucency for optimum X-ray images and an advanced 3D architectural planning tool providing a 3D visual of possible room configurations. It’s an impressive piece of kit.

“The hybrid operating room suite meets this growing need for multipurpose functionality and minimally invasive interventions to address a spectrum of cardiac conditions – structural and degenerative,” the press release says. “It provides a solution that combines the equipment needed to perform open and endovascular cardiac procedures within the same room.

“The hybrid operating room concept is a significant breakthrough in facilitating procedural collaboration between specialties, with hybrid operating room procedures being coded by payers as a single procedure to encourage clinicians to make the best choice for the patient without the need for cost considerations. Surgeons and interventionalists believe this concept will enable them to provide a wider range of treatments, improve care and reduce procedure costs.”

All on the table

The key to building a successful hybrid operating room such as this, explains Radder, is collaboration between companies with expertise in different surgical technologies and components. “Collaboration is great,” he says. “Health and healthcare is a complex area, and we feel that if you really want to make changes in this space and solve complex problems, you need to work together. So this is one collaboration we have that has been going on for a long time and, together with Maquet, we offer a really good hybrid operating theatre solution.

“Maquet is very good, for example, at providing solutions that make the transition between minimally invasive procedures and open surgery happen, whereas Philips is very well known for our interventional cath labs.

“To give you a very simple example: if you want to do an operating procedure in the same room, you need to have a special table. So the table, in our case, will be a Maquet table, and that’s one of the enablers that we need to do that surgical intervention.”

Of course, it’s not just hybrid operating rooms that are changing the way surgical care is delivered, however important they are. From personalised simulation technology, where surgeons can rehearse an intervention on a particular patient, to telesurgery, where specialists in Dubai can operate on patients in Cairo, operating rooms are becoming more intelligent, and the opportunities for patients, surgeons and governments
are massive.

With record levels of investment, growth and innovation in the healthcare market across the Middle East, the future for operating room technology in the region certainly looks exciting.