advanced cardiovascular surgery hybrid operating room (nuts & bolts)
TRANSCRIPT
JACQUES KPODONU,MDABS,ABTS,ABVM
Cardiovascular Hybrid OR: The Travelled Road
The Times Are Fast Changing: Are We Prepared?
Patient demand, changing healthcare landscape demand for a new working
environment(Hybrid OR)
Vascular Surgery
.
Plans Equipment Imaging OR table
Key success factors for building an advanced cardiovascular hybrid room:
Clinical Procedure
Requirement Assessment Planning
Project ManagementPartner Management
Cardiovascular Hybrid Operating RoomImaging and surgical equipment in one room
Monitors incl. catheterization
software
3D C-Arm with 80 - 100kW
Sterile environment
OR imaging table e.g. floating table top or traditional breakable OP-
table
Anesthesia equipment
Radiation shielding
Define space based on facility needs address costs Build a functional team including physicians, nurses,
technicians, infection control, environmental services and vendors
Define roles and responsibilities of all parties involved (who owns project coordination) ? Hybrid surgery program director
Decide on imaging equipment and table Define suppliers/vendors for other equipment Always start by identifying imaging equipment location Define all other equipment locations and requirements, i.e.
ceiling lights ,surgical and video integration surgery workflow
Iterative verification of coordination and planning of all vendors in CAD
Reviews of solutions with user group/team (verify that needs are met)
Sign-off concept (vendors and users!!!) Anticipate Future Technologies
Exemplary process in a Hybrid OR Project
Lighting Displays/Monitors
Imaging (Live, Reference, 3D, PACS…) Video Integration (Endo, Ultrasound, Microscope, Navigation….)
Communication and Digital Data Integration Audio (wired, wireless, etc.) Control Room to Operating Room Acoustics
Equipment Reaches especially pendants/utilities Point of use Park positions
Ceiling and Floor Structure Requirements Mass grid option (alignment of all lots!)
Renovation Issues, incl. HVAC and electrical installation Use proper CAD blocks for all equipment and create one single “Masterplan”
Topics to be discussed in Every Hybrid OR Project
Total Investment for Hybrid Operating roomsHoag -$6.7 million
The Road to Hybrid OR – ChallengesPeople and Workflow – It’s a busy place! (room planning)
Plan in 2D Visualize in 3D
OR-Room
Technical-RoomControl-Room
Ane
sthe
sia
Are
a
Nur
ses/
ster
ileW
orks
pace
SurgicalWorkspace
SurgicalWorkspace
Patient
Schematic Room Layout – Important areas for workflow considerations
... and other equipment increases complexity
1. Angiography system2. Contrast injector3. Operating table4. Operating lights5. Anesthesia/respirator/
injectors6. Heart-lung machine7. Ultrasound
(TEE/intravascular ultrasound)8. Surgical instruments /
catheter trolley9. Electrocautery10.Defibrillator11.Cell saver12.IABP13.Ceiling pendants
Cardiovascular Surgery Hybrid Program (Hoag Model)led by endovascular cardiac surgeon
Endoaortic /open aortic surgery program Surgical valve/transcatheter valve program Hybrid maze program Surgical revascularization/hybrid revascularization program Hansen robotic endovascular program)endovascular robotics) Da Vinci robotic surgical program Image guided surgery program MRI /3D CT cardiac imaging program Echocardiography /Intravascular ultrasound imaging program Carotid surgery/ carotid stent program Peripheral vascular surgery program Vascular laboratory program Image guided surgery research program collaboration with Siemens
Phase 1 April 2011
December 2011
December 2011
December 2011
December 2011
December 2011
Phase 5 December 19 2011 $6.7 million
Trans-Catheter Aortic Valve Program:
3D Dyna CT performed in a hybrid OR to accurately size
and deploy trans-catheter valves
procedural details
Endo Aortic Program: CT Fusion Registration for EVAR Guidance In a Hybrid Operating Room
Setting.Preoperative CT scan is exported to the hybrid operating room and fused with a non contrast Dyna CT scan obtained in the operating room .Fusion technology of 2 CT volumes enables real time navigation and placement of sheaths, wires and devices without need for contrast injection.Co registration of IVUS with Fused CT /fluoro images can further decrease use of contrast in renal impaired patients requiring EVAR.
Registration of 3D CT with fluoroscopy with IVUS integration
.A marker is placed perpendicular to the IVUS probe (arrow) on the patient under fluoroscopic guidance to correspond to the location of the renal vessels ostium as determined by IVUS imaging co registered with fusion CT/fluoroscopy.
Endo-Aortic Program: Thoraco-abdominal Endograft.
Hybrid TAAA graft
Fusion CT
1.Endo-Aortic Program: Thoraco-abdominal Endograft
Endo-Aortic Program: Arch-Aorta Endograft.
Arch aneurysm Branched arch endograft
Post repair arch
Courtesy cook Australia
Possible Future Applications
Image guided minimally invasive surgery
Intraoperative Angiosystem
2D FluoroIntraoperative
3DFunctional
Imaging
Robotics
Image Fusion withMR, CT, US, Endoscopy
Tracking / Navigation
Functional Imaging for CAD (CABG: Pressure, Velocity, FFR)
Rajani R: Eurointervention 2013; 9; 277-83
Functional ImagingPrototype Version – Not commercially available
Blood Velocity VectorsVolumetric Blood Velocity Magnitude
Blood Pressure on Wall
Blood Flow Streamlines
Model automated modeling of mitral valve
*Not commercially available. Due to regulatory reasons its future availability cannot be guaranteed.
automated modeling of aortic valve
*Not commercially available. Due to regulatory reasons its future availability cannot be guaranteed.
Perceptive technology: true understanding of form, flow and function
*Not commercially available. Due to regulatory reasons its future availability cannot be guaranteed.
3D CT mitral valve analysis software for image guide mitral valve surgery/intervention program.
Co-Registration of Data Sets
Fusion of Optics and syngo DynaCT
OUR GOAL: Adding life to years …OUR GOAL: Adding life to years …
In summary: Involve all stakeholders as early as possible in the project!
Discuss layout/concept with all involved parties on hospital and vendor side
Involved parties may be:Scrub nursesBusiness managerPlanning departmentProject ManagerOther vendor representativesSurgeons/interventionalistsTechnical directorHygienistAnesthetist
Questions