1) The document discusses the key factors for building an advanced cardiovascular hybrid operating room, including clinical requirement assessment, planning, project management, and partner management. 2) Some of the main considerations for a hybrid OR layout are ensuring adequate space for imaging equipment, surgical equipment, anesthesia equipment, and radiation shielding. Workflow for medical staff and patients must also be considered. 3) Building a hybrid OR requires defining roles and responsibilities, deciding on equipment, and iterative planning and verification between all involved parties to ensure needs are met. Total investment for a hybrid OR project can be over $6 million.

1. JACQUES KPODONU,MD
ABS,ABTS,ABVM
Cardiovascular Hybrid OR: The Travelled Road

2. The Times Are Fast Changing: Are We
Prepared?

3. Patient demand, changing healthcare landscape
demand for a new working environment(Hybrid OR)
Vascular
Surgery
.

4. Plans Equipment Imaging OR table
Key success factors for building an advanced
cardiovascular hybrid room:
Clinical Procedure
Requirement Assessment
Planning
Project Management
Partner Management

5. Cardiovascular Hybrid Operating Room
Imaging 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

6.  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

7.  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

8. Total Investment for Hybrid Operating rooms
Hoag -$6.7 million

9. The Road to Hybrid OR – Challenges
People and Workflow – It’s a busy place! (room planning)

10. Plan in 2D Visualize in 3D

11. OR-Room
Technical-Room
Control-RoomAnesthesia
Area
Nurses/sterile
Workspace
Surgical
Workspace
Surgical
Workspace
Patient
Schematic Room Layout – Important areas for workflow
considerations

12. ... and other equipment increases complexity
1. Angiography system
2. Contrast injector
3. Operating table
4. Operating lights
5. Anesthesia/respirator/
injectors
6. Heart-lung machine
7. Ultrasound
(TEE/intravascular ultrasound)
8. Surgical instruments /
catheter trolley
9. Electrocautery
10.Defibrillator
11.Cell saver
12.IABP
13.Ceiling pendants

13. 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

14. Phase 1 April 2011

15. December 2011

16. December 2011

17. December 2011

18. December 2011

19. December 2011

20. Phase 5 December 19 2011 $6.7 million

21. Trans-Catheter Aortic Valve Program:
3D Dyna CT performed in a
hybrid OR to accurately size
and deploy trans-catheter
valves
procedural details

22. 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.

23. 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.

24. Endo-Aortic Program: Thoraco-abdominal Endograft.
Hybrid TAAA graft

25. Fusion CT
1.Endo-Aortic Program: Thoraco-abdominal
Endograft

26. Endo-Aortic Program: Arch-Aorta Endograft.
Arch aneurysm
Branched arch endograft
Post repair arch
Courtesy cook Australia

27.
Possible Future Applications

28. Image guided minimally invasive
surgery
Intraoperative
Angiosystem
2D Fluoro
Intraoperative
3D
Functional
Imaging
Robotics
Image Fusion with
MR, CT, US, Endoscopy
Tracking / Navigation

29. Functional Imaging for CAD (CABG: Pressure, Velocity, FFR)
Rajani R:
Eurointervention 2013;
9; 277-83

30. Functional Imaging
Prototype Version – Not commercially available
Blood Velocity Vectors
Volumetric Blood
Velocity Magnitude
Blood Pressure on
Wall
Blood Flow
Streamlines

31. Model automated modeling of mitral valve
*Not commercially available. Due to regulatory reasons its future availability cannot
be guaranteed.

32. automated modeling of aortic valve
*Not commercially available. Due to regulatory reasons its future availability cannot
be guaranteed.

33. Perceptive technology: true understanding of form, flow and function
*Not commercially available. Due to regulatory reasons its future availability cannot
be guaranteed.

34. 3D CT mitral valve analysis software for image guide mitral valve
surgery/intervention program.

35. Co-Registration of Data Sets

36. Fusion of Optics and syngo DynaCT

37. OUR GOAL: Adding life to years …OUR GOAL: Adding life to years …

38. 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 nurses
Business manager
Planning department
Project Manager
Other vendor representatives
Surgeons/interventionalists
Technical director
Hygienist
Anesthetist

39. Questions