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Vascular hybrid room integrated in the operating room comprising a biplane digital subtraction angiography unit with multipurpose surgical capabilities. By courtesy of www.siemens.com/ healthcare-magazine.
Source publication
The last two decades have seen a paradigm shift in the treatment of vascular related diseases from once traditional open surgical repairs to the entire vascular tree being amenable to percutaneous interventions. Neither the classic operating room nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Im...
Context in source publication
Context 1
... operating room should ideally be between 50- 85 square meters, with a minimum clear area of 37- 45 square meters. Floor to ceiling heights should be at minimum 3 meters to accommodate floor or ceiling mounted C-arms capable of rotational angiography for volume rendering 3D CT-like images achieved with advanced biplanar imaging systems (Fig. 2). In the existing operating rooms, the fixed ceiling-mounted C-arm requires some structural modifications to in- stall the mounting plates and run electrical conduits under the floor to the components. Most states dictate that vascular hybrid room with a fixed imaging sys- tem must have lead-lined walls. Most standard vas- cular hybrid ...
Citations
... However, radiation safety is widely dependant on the exposure time and the distance from the radiation source which means that the staff (usually the nursing staff) located far from the C-arm are more protected (ICRP, 2007). Some studies focus on room design regarding necessary dimensions and technology but also concluding that hybrid ORs needs interdisciplinary planning (Hudorovic, Rogan, Lovricevic, Zovak, & Schmidt, 2010;Gofrit et al., 2016). Studies from the perspective of the staff and their collaboration investigate how the staff roles may change through negotiation and dynamic procedures during the introduction of new technology, such as the hybrid OR (Lindberg, Walter, & Raviola, 2017). ...
Technical advancements in the operating room setting continue, and the concept of the hybrid operating room is promoted and accepted worldwide. The hybrid setting means inclusion of radiology in the already complex environment of a traditional operating room. Collaboration in this type of environment becomes essential and investigating how the nursing staff experiences this collaboration in the hybrid operating room is needed. The aim of the study was to investigate how the nursing staff from the specialties of surgery, anesthesiology, and radiology experienced collaborating in a hybrid operating room. Explorative qualitative design was used. Five focus groups consisting of operating room nurses, operating room assistant nurses, nurse anesthetists, assistant nurse anesthetists, and radiographers were included in the study. Interviews using semistructured questions were conducted. Directive content analysis was used for the data analysis. The following categories revealed: (1) different patient safety perspectives; (2) responsibilities being shared and divided; (3) collaboration becoming better over time; (4) uneven division of labor in a strained work situation and different terms of employment; (5) lack of education and joint meetings; and (6) environmental constraints for satisfying collaboration. The nursing staff in the hybrid operating room highlighted they worked toward a common goal but prioritized their own specific tasks rather than the procedure as a whole. This, together with the uneven task distribution and unclear responsibilities, could create tension between the different staff categories, impacting procedures negatively. The results revealed the importance of proper preparation of the staff to work in the hybrid operating room. Having team building activities, common meetings, relevant training to meet educational needs, and adjusting the team composition could improve hybrid operating room collaboration and improve patient safety and outcomes.
... A hybrid room can accommodate both IR and surgical intervention, which can significantly save time when it is crucial for patients ( Figure 1) (4). ...
... (3) The hybrid approach can result in decreased risk, less invasive procedures, and improved outcome [21]. The residence time in the operating room is short; therefore, the postoperative recovery and prognosis are excellent. ...
... A systematic postoperative follow-up plan should also be conducted, and second-stage operative schemes executed as soon as possible. It should be noted that the application of the hybrid procedure for the treatment of PA/IVS is still in its infancy, and the best methods for hybrid operating room construction, improvement of interventional devices, and other aspects require additional clinical exploration and research [21]. ...
Background
To summarize our clinical experience in performing transthoracic balloon pulmonary valvuloplasty for the treatment of patients suffering from congenial pulmonary atresia with intact ventricular septum (PA/IVS).
Material/Methods
Between April 2009 and April 2016, 38 patients with PA/IVS underwent transthoracic balloon pulmonary valvuloplasty in our hospital. All of them were combined with patent ductus arteriosus, tricuspid insufficiency, and atrial septal defect or patent foramen ovale. The valvuloplasty was performed from the right ventricular outflow tract through a median sternotomy incision under TEE guidance for all cases.
Result
Thirty-five patients were successfully discharged, and 3 patients died after the operation. The 35 surviving patients were followed up. Spo2 in the 35 patients was 88–96% after the operation. The transpulmonary valvular gradient pressure was less than or equal to 30 mmHg in 31 patients and between 36 and 52 mmHg in the other 4 patients. After the surgery, tricuspid regurgitation was significantly reduced. We found only 4 patients with moderate regurgitation, 5 patients with mild to moderate regurgitation, and mild regurgitation in the remaining 26 patients. Five patients underwent a second-stage operation, including biventricular repair in 4 patients and ligation of ductus arteriosus in 1 patient.
Conclusions
The application of transthoracic balloon pulmonary valvuloplasty for the treatment of PA/IVS is minimally invasive and safe, which has great significance for improving the curative effect for this condition and reducing operation mortality.
... However, there are several limitations that apply (12). First, the general size of a hybrid operating facility requires a relatively large operating space for the installation of equipment necessary for performing both open and closed procedures (7). Otherwise, the cost of room modification would be higher than it would be for conventional angiography suites and operating rooms. ...
... The mHOT that we developed has several advantages over commercially available hybrid tables (for example, MAQUET MAGNUS, Philips, Best, The Netherlands) in the operating field. Commercially available hybrid tables use floor-mounted systems that interrupt rapid panning over wide anatomic areas and limit the potential success of procedures (7). On the other hand, the mHOT provides for free installation, where the table is easily mounted to the floor and is readily moveable from room to room as required. ...
Background:
The integration of interventional and surgical techniques is requiring the development of a new working environment equipped for the needs of an interdisciplinary neurovascular team. However, conventional surgical and interventional tables have only a limited ability to provide for these needs. We have developed a concept mobile hybrid operating table that provides the ability for such a team to conduct both endovascular and surgical procedures in a single session.
Methods:
We developed methods that provide surgeons with angiography-guided surgery techniques for use in a conventional operating room environment. In order to design a convenient device ideal for practical use, we consulted with mechanical engineers.
Results:
The mobile hybrid operating table consists of two modules: a floating tabletop and a mobile module. In brief, the basic principle of the mobile hybrid operating table is as follows: firstly, the length of the mobile hybrid operating table is longer than that of a conventional surgical table and yet shorter than a conventional interventional table. It was designed with the goal of exhaustively meeting the intensive requirements of both endovascular and surgical procedures. Its mobile module allows for the floating tabletop to be moved quickly and precisely. It is important that during a procedure, a patient can be moved without being repositioned, particularly with a catheter in situ. Secondly, a slim-profile headrest facilitates the mounting of a radiolucent head cramp system for cranial stabilization and fixation.
Conclusion:
We have introduced a novel invention, a mobile hybrid operating table for use in an operating suite.
... This fully integrated neurovascular hybrid room provides surgical sterility combined with flat-panel vascular imaging, biplanar three-dimensional imaging capabilities, postprocessing, and image storing capabilities. Endovascular and open surgical repairs benefit equally from this dual capacity working environment (Hudorovic, Rogan, Lovricevi c, Zovak, & Schmidt, 2010). This environment provides enhanced safety and economy for the patient. ...
With the development of hybrid operating room (OR) capabilities and rapid advances in neuroendovascular surgical techniques, the list of options able to be offered to patients with cerebral vascular pathology has grown enormously. Despite advances in equipment and technique, many treatable anomalies remain inaccessible because of pathologic and age-related features in vessels that must be traversed to reach the cerebral vasculature. This case study illustrates how the hybrid OR environment enables collaboration between surgeons from complementary subspecialties that results in net benefit to this patient with aneurysmal subarachnoid hemorrhage and forbiddingly tortuous vasculature.
The last two decades have seen remarkable advances in imaging and procedural-guidance technology. Enhancements in computing, sensors, and data processing now allow many imaging modalities to produce information that can be displayed, transmitted, and utilized in real time. This has allowed the immediate use of imaging modalities to guide surgery and interventional therapies, with improvements in patient care and outcome. Until recently, diagnostic imaging, surgery, endoscopy, and interventional radiology had developed and evolved fairly independently. In the past, procedural rooms were generally designed with a single discipline in mind. We are now asked to construct enhanced work environments which support multidisciplinary workflow and novel-navigated therapeutic procedures. In these new image-enhanced working environments, the collection, processing, and display of information are rapidly evolving. Accompanying these changes in the workflow is increased demands on staff, on infrastructure, and on additional equipment needed to support integration of new technologies. This chapter discusses the design of these rooms. The goal in interventional OR design is to produce functional spaces that are safe and efficient and that have the capacity to support the development and evolution of new technologies and equipment with minimal construction changes.
Patients with diabetes mellitus often suffer from diabetic foot syndrome, a condition leading to foot ulceration or even amputation of lower extremity. Peripheral neuropathy combined with repetitive trauma to the foot and peripheral vascular disease are the main etiological factors in the development of foot ulcers. Other major contributive factors include the effects of callus, increased plantar pressures, and local infections. Patient education concerning their disease has a central role in the prevention of foot ulcers. Ordinary preventive measures taken by the patient include regular self-inspections, appropriate daily hygiene of the feet, appropriate footwear to reduce plantar pressures, and medical pedicure performed by a pedicurist experienced in diabetic foot patients. The importance of callus in diabetic patients has been shown in several studies by high predictability of subsequent ulcer development in patients with plantar calluses. For removing callus, urea based preparations are considered to be the treatment of choice. In case of local bacterial and fungal diabetic foot infections, systemic antibiotic and systemic antimycotic therapy is indicated, respectively. Wound dressings of various types are the mainstay in the treatment of chronic foot ulcers with avoidance of occlusive dressings in infected ulcers. Since the vast majority of ulcers and amputations can be prevented in diabetic patients, proper diagnosis and multidisciplinary approach are essential.
