Hybrid ORs are an emerging trend at more and more clinics nowadays. Christian Tebel, head of Professional Services at TRUMPF Medical Systems, explains what hybrid ORs are and what advantages they offer.

Hybrid ORs are a topical issue at the moment. What is behind it all?

Christian Tebel: Basically a hybrid OR is a combined operating room containing large imaging equipment, such as MRT and CT, that enables intraoperative diagnostics. If provided for in the hygiene and room concept, the hybrid OR can also be used purely as a diagnostics room or as a classic operating room.

Likewise operating rooms with integrated inpatient or mobile angiography devices are also called hybrid ORs. Simply imagine an operating room with a completely equipped cardiac catheter laboratory.

This definition of a hybrid OR has gained increasing acceptance in recent years because more and more cardiologists and vascular surgeons employ hybrid procedures. Specifically this means that interventional treatment by means of a vascular catheter, for instance, is combined with open surgery treatment.

What is typical for a hybrid OR?

Tebel: A hybrid OR enables a multitude of new surgical procedures – for virtually all disciplines. New potential areas of application are emerging especially in trauma and orthopedic surgery, neurosurgery, cardiac and vascular surgery.

For what operations is a hybrid OR particularly well suited?

Tebel: Take vascular surgery as an example. The trend here is shifting increasingly from open surgery to endovascular procedures, and also open and interventional therapies are combined. This is feasible in a hybrid OR. Even if open surgery is indicated for an endovascular or minimally invasive operation in an emergency case, this is possible in one time-saving session involving less risk and strain for the patient. Another example from the field of neurosurgery: in this case intraoperative imaging serves to update preoperative image and navigation data. This results in key advantages with respect to perioperative delimitation of tumor tissue and determination of resection borders

And what is the benefit for the clinic? Buying or changing over to a hybrid OR is not exactly cheap.

Tebel: Purchasing large devices, such as MRTs, CTs or angiography equipment, is always a big investment. So it’s all the more important to use such equipment as economically as possible. If this is done in a hybrid OR, both human and technical resources can be utilized optimally. Integration of a hybrid OR into the central OR department generates the most advantages. In particular because a hybrid OR permits interdisciplinary applications and is thus available to the OR management as an operating room resource. In short, once the hybrid OR is set up, the clinic can save enormous costs through its use and additionally optimize the selection and quality of the treatment methods. This also increases patient and staff satisfaction.

What are the most important prerequisites for interdisciplinary use of a hybrid OR?

Tebel: The key factors include the right room design and an appropriate selection of technical equipment. At the same time the imaging device and operating table have to form an integral unit. Planning therefore plays a crucial role here since both the room concept and the technical equipment have to be adapted to the respective in-house procedures and concepts. As far as choosing the right operating table system is concerned, an interchangeable table top system with a fixed column offers the greatest scope. It ensures that a defined reference point is provided in the room for the imaging devices. Moreover, you can take advantage of the entire spectrum of operating table tops and diagnostic table tops. This is the basis for interdisciplinary use. The hybrid OR thus becomes an interdisciplinary room.

What is the situation in practice then?

Tebel: An example of an X-ray system suitable for interdisciplinary use in a hybrid OR is the SIEMENS Artis Zeego. The C-arm and an exclusively developed version of the TRUMPF operating table system TruSystem 7500 work together “as a team”. This means both devices know where the other one is positioned. That is the basis for integrated collision protection. Furthermore, the C-arm and the operating table can be controlled via a joint control platform if necessary.

And a clinic can simply install this in an OR?

Tebel: It’s not quite that easy. When you equip an interdisciplinary hybrid OR with a CT or MRT, you first have to keep the room concept in mind. Nowadays multi-room concepts are also implemented. In this case the large equipment is mobile and can be used alternately in two or even three rooms. No matter whether it involves a CT, MRT or devices like Artis zeego. In every case there are additional requirements regarding room size as well as control and technical rooms. This is easier to accomplish during the early planning phase for new buildings. If you subsequently install equipment in hybrid ORs, things get more difficult. Frequently, however, adjoining rooms are available for the respective use in central OR units. If they are “rededicated“ and OR logistics, OR procedures and the OR concept are optimized at the same time, you “kill two birds with one stone”.

The factors that guarantee smooth incorporation of an interdisciplinary hybrid OR into a central OR unit include exact planning and prompt integration of the users in order to boost acceptance of interdisciplinary use. I mean by that: not only does the equipment work as a team in the hybrid OR, but also different and, from a historical viewpoint, “non-OR-related” disciplines have to function as a team in the hybrid OR. The same applies to the companies whose medical technology products are to work together in the hybrid OR.

That sounds like a big challenge for clinics and manufacturers. Is it worth tackling this challenge?

Tebel: I believe hybrid ORs are the future. There are fewer and fewer classic open OR procedures. This makes it necessary to integrate imaging into the operating room. Disciplines of internal medicine, with their interventional and endoscopic procedures, increasingly work hand in hand with surgical disciplines, with their open and minimally invasive methods. Even radiology cannot avoid this trend towards integration. The specialized departments are joining forces more and more. Industry, too, has to accept this development. The hybrid OR is one of the main drivers of this development. No supplier can cope with the complexity of the hybrid OR alone. Here again teamwork is called for.

What hurdles have to be overcome?

Tebel:  Trends always involve hurdles. Most of the time they are naturally related to the available budget. Another factor in the case of hybrid ORs is that an understanding regarding optimum exploitation of resources has to grow and even greater focus must be placed on the importance of cooperation between clinics, planners and industry. If we succeed in overcoming these hurdles, the realization of hybrid ORs will turn out to be more than just a trend!