Interview with Dr. Sven Seifert of the Clinic for Thoracic, Vascular and Endovascular Surgery at the Clinical Research Center Chemnitz
Performing surgery in a hybrid operating room is meant to be a relief for the staff and offer patients new options for treatment. What is actually so different about this hybrid operating room, what can you expect and what should you keep in mind during the planning process? MEDICA.de asked Dr. Sven Seifert, Clinical Research Center Chemnitz, who is also going to introduce the subject at the MEDICA EDUCATION CONFERENCE 2015.
Dr. Seifert, what do physicians want from their hybrid OR?
Sven Seifert: That always depends on the medical specialty of the physician. A neurosurgeon wants a hybrid operating room with an open MRI scanner, a vascular surgeon prefers the option of intraoperative 3D-rotational angiography. A hybrid operating room is essentially an operating room where you can apply additional technical procedures under sterile conditions that are not possible to perform in a regular operating room.
What are the pros and cons of a hybrid operating room?
Seifert: The one advantage is that the hybrid operating room offers significantly more space and features more modern equipment than traditional operating rooms. Technical and imaging systems have already been set up here that would otherwise first need to tediously be brought into the OR. Here you can create images with MR or X-ray technology on site, calculate models based on it that merge with already existing images and thus simulate implants and their fit. This reduces the radiation exposure for patients and staff and the surgery thus becomes more accurate and safe.
The drawback of a hybrid operating room: the investment costs are substantial. Of course, a hybrid is currently still a marketing tool for centers and hospitals. However, ultimately patients are also demanding this type of modern medical technology. Not every hospital will be able to afford this type of hybrid operating room. The total maintenance costs and the technical operating expenses are also higher. On the other hand, the surgeon can operate the technology on his/her own which saves personnel expenditures. There are no longer any cables on the floor as is the case with mobile technology and the image quality and structure visibility is many times higher.
Were you trained to use the hybrid operating room?
Seifert: In our clinic, the entire health personnel was trained for one week based on a previously designed time schedule. All associates were trained at least twice per ward. This is absolutely necessary. After that week, we resumed daily operations and were still supported by the manufacturers of our hybrid operating room system. The learning curve to truly feel confident with the new OR is approximately three to four weeks. You can then safely use all the basic functions without running the risk of something not working or putting the patient at risk.
Were you also trained for emergency situations?
Seifert: There are backup scenarios in case the technology completely fails. The main technology has an emergency support function of course. That means, there are emergency monitors and a very large emergency backup generator so you can safely complete the surgery during an emergency. Of course, there are also company hotlines and our in-house technology for smaller issues.
Is there any technical equipment in your OR where you say, "That’s nice to have but really not the right tool?"
Seifert: The deeper you delve into the technology and its possibilities, the more you come up with ideas of what else you might be able to do or what you would still like to see. The companies are also interested to hear about this of course. We have actually already passed some ideas along on how the devices could be designed differently or how you can better plan sequences, for instance in terms of software. In fact, we specifically collaborated on a new software update that now entered the market.
What tip would you like to give colleagues that are still in the early stages of their planning process?
Seifert: Start your planning process early and bring in all involved parties if possible – ranging from care nurses, nurse anesthetists, anesthesiologists, surgeons and nurses all the way to technicians and management. Think through all the processes together. What do we want to accomplish in what way and how often in the OR? Plan this very precisely. Not every hybrid OR needs a Category 1A hygiene standard, that being the standard for open heart surgery.
My second tip: don’t plan too small but plan generously. A hybrid OR should be at least 80 square meters in size. What’s essential is that you regularly meet with everybody and talk through everything. Unfortunately, in many hospitals, the processes are not properly described. Who does what? Who walks from point A to B and when? You need to know all this. When you review this, you will see all of the improvements you can make. In addition, a 3D simulation of the planned hybrid OR is very helpful. Most companies offer this type of tool at this point. Here you can see if the collaboration in the OR is going to work, whether you are able to position the patient correctly, whether the anesthesiologist is able to reach everything properly or whether the surgeon has a clear view of all monitors. I thought this was extremely helpful and important during our planning process.