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Without ever leaving the operating room, a Vascular Surgery team used ultrasound, CT and fluoroscopy technologies during a stent graft surgery to treat a patient’s abdominal aortic aneurysm earlier this month. The case was the first to be performed in the new Hybrid OR in the Shapiro Cardiovascular Center.
“The Hybrid OR brings into the operating room many imaging technologies previously only available in imaging suites outside the OR,” said Michael Belkin, MD, chief of Vascular Surgery, who performed the first surgery in the Hybrid OR.
Among the first of its kind in the country, the Hybrid OR enables staff to perform 3D angiography, CT-like imaging and intravascular ultrasound in an operating room. “Using images, whether X-ray, MRI, Ultrasound or PET, is a way to ensure the precision and optimal safety of many surgical procedures,” said Steven Seltzer, MD, chief of Radiology.
The room boasts a Siemens Artis Zeego, a multi-axis system based on robotic technology that can be positioned any way staff want and provides cross-sectional, large volume 3D imaging comparable to that of a traditional CT scanner.
That means one-stop shopping for many patients who can have imaging and treatment in one setting, where multiple trips were required in the past. Patients who require a stent and then heart valve repair, for example, previously needed to have the stent inserted in the Cardiac Catheterization Lab and valve repair subsequently in the OR.
“The Hybrid OR provides a true benefit to patients, and we’ve only scratched the surface on this one,” said Chip Bolman, MD, chief of Cardiac Surgery. “It’s truly a patient-centered operating room, with multiple care providers and varied expertise right there in one room surrounding the patient.”
The Hybrid OR requires true collaboration between departments and disciplines in order to run smoothly. “The collaboration has been phenomenal so far,” said Pearl Cunningham, RN, nurse manager of the OR. “Previously Radiology and the surgical teams provided care as different teams, collaboratively. In the Hybrid OR, those providers comprise a multi-disciplinary, multi-department team, working in alignment to achieve success.”
Prior to each case, all team members, including the surgeon, nurse, scrub technician, anesthesiologists and imaging technologists, meet to communicate the goals of the procedure and what type of imaging should be used to accomplish them.
“The surgical team is getting a new family member: the imaging technologist,” said Carol Upson, chief technologist of Abdominal and Neuro Interventional Radiology. “We’re the experts in knowing how to position someone to get the best images, and surgeons and nurses are the experts in knowing the best position for the patient for surgery. Communication is the key to success, and communication thus far has been awesome. Everyone has really come together as a team very quickly.”
The Hybrid OR opens up doors to new procedures, such as branched endografts for thoracoabdominal aneurysms and percutaneous heart valve repair, for which imaging is crucial. “We see so many multi-service procedures now,” Cunningham said. “If we have a patient having a cardiac procedure that needs imaging and vascular surgery, this OR really gives us the ability to provide the best outcome for these patients. We can expand the boundaries of care.”
The Hybrid OR also promises to improve care in life-threatening emergencies. Patients suffering from emergency aortic dissection, a treacherous tear or lesion in the aorta that can lead to a stroke or the loss of leg use, are among those who will benefit. “With ultrasound available in the room, surgeons can operate upon diagnosis, and, with CT and intravascular ultrasound, we can design and deliver treatment right there,” Bolman said.
“This really is the way of the future, not just at BWH but across the country,” Upson said. “This technology will eventually be the new standard of care for patients.”
For information, contact Michael Davidson, MD, for Cardiac Surgery, and Michael Belkin, MD, for Vascular Surgery.
See a photo gallery of the Hybrid OR.