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Less invasive procedures open door for hybrid operating rooms

Rochester Business Journal
August 17, 2012
Hybrid operating rooms are establishing a presence in Rochester as heart procedures become smarter and less invasive.

A cardiovascular hybrid operating room combines the imaging technology of a radiology suite and the high sterility standards and surgical equipment of an operating room. It also has the necessary tools for anesthesiologists.


These operating rooms let surgeons perform procedures in new ways. Instead of cutting patients open to see the organs and arteries, doctors can make a small incision and use microscopes, cameras and small endovascular tools to navigate through blood vessels.


"In this day and age of using imaging and stents, hybrid operating rooms offer a great deal more flexibility and latitude in terms of treating patients than does a standard OR," says George Hicks M.D., chief of cardiac surgery, program director for cardiothoracic surgery and professor of surgery at the University of Rochester's School of Medicine and Dentistry.


The University of Rochester Medical Center and its affiliates have multiple hybrid operating rooms. One at Strong Memorial Hospital opened in 2000, and a second one at Strong is in the planning stages. The first is mainly used for vascular and cardiac surgery but can be used for neurological surgeries; Hicks predicts that when the second opens, it will take more of the neurological surgeries. 


Highland and F.F. Thompson hospitals have mobile, as opposed to fixed, hybrid operating rooms. This means that the imaging technology needed to make an operating room hybrid can be wheeled in. The downside, says David Gillespie M.D., chief of the division of vascular surgery at URMC, is that the image quality is not as high.


Rochester General Hospital has a hybrid operating room that surgeons use for cardiac and vascular surgeries, which officially opened in 2009. It is often called the endovascular suite, which refers to its use for surgeries that go through major blood vessels. 


The alternative to hybrid operating rooms, which heart patients may be more familiar with, is the cardiac catheterization lab. With the imaging technology in this type of room, diagnostic and therapeutic procedures can be done but not invasive surgeries. Information gained from the technology in the catheterization lab can be helpful in performing subsequent operations, but surgeons cannot glean information and make surgical decisions simultaneously, as they can in a hybrid operating room.


Patrick Riggs M.D., chief of RGH's Vascular Surgery Associates, says the "oversimplified difference between a hybrid OR and cath lab is that we are set up to work on patients with sterile instruments, and we're positioned to cut somebody open."


But in hybrid operating rooms, surgeons rarely make large, significant incisions. For instance, Riggs says, instead of opening a patient's chest, an incision can be made into an artery in the leg, and small tools and imaging technology can be sent up toward the heart.


The kinds of procedures done in a cardiac or vascular hybrid operating room combine surgical and therapeutic procedures. Riggs says the hybrid operating room at RGH was built primarily for fixing aneurysms.


"We fix those with covered stents that actually go up inside the blood vessel and realign it from inside," he says.


Riggs says this is considered a hybrid procedure because doctors may be opening part of the vessels noninvasively with the stents and also bypassing an organ after opening part of the chest.


Combined procedures can help the patient in an effective and time-efficient way. The technology allows surgeons to do both types of procedures at one time in one place, instead of having to reopen a patient later.


Further, since hybrid procedures are typically quicker than invasive ones, patients are on the table for less time and are less likely to get infections. Other benefits of doing procedures in a hybrid operating room, according to Gillespie, are decreased patient pain, lower costs and shorter hospital stays.


The technology allows surgeons to do operations they may not have been able to do otherwise.


Early indications suggest that procedures done in an endovascular hybrid operating room have lower mortality rates, Hicks adds.


But because hybrid operating procedures are so new, it is still early to pinpoint their success. They only really sprang up two decades ago, when vascular surgeons were experimenting with new ways to put vascular stents in the abdominal aorta.


"That was kind of the beginning of the surgical use of imaging," Hicks says. 


When compared with procedures that require opening a patient's chest, endovascular procedures done in a hybrid operating room have lower mortality rates, according to follow-ups in five or 10 years. Longer-term results are not available.


A challenge for health care providers is the cost associated with hybrid operating rooms. The suite at RGH was a $4.5 million project, documents from the Rochester General Hospital Foundation show. Even follow-ups on endovascular procedures are more expensive. Because the technology is smaller and there are no entry sites, computed tomography scans and ultrasounds are needed.


Construction of the hybrid operating room is costly as well. It requires years of planning and input from architects, equipment specialists, surgeons and various other professionals. The expensive imaging technology must be properly mounted to a wall or the ceiling, and light fixtures, power sources and anesthesiology equipment must also be planned and paid for.


Despite the expenses, surgeons seem to agree that hybrid operating rooms will become the norm because the benefits outweigh the costs.


"You're seeing traditional ORs less and less," Gillespie confirms.


Says Hicks: "Most hospitals that want to be in the game of endovascular surgery either have a hybrid approach with a cath lab setting or a hybrid approach within the operating room."


Hospitals with one hybrid operating room may realize years later that they could benefit from another, as URMC did.


"I think the needs for hybrid operating rooms are kind of under control right now in the city, but it wouldn't surprise me if as time goes on we find more uses and there are more needs," Riggs says.


Hicks say the technology is likely to draw patients to URMC. For now, especially with expansion on the horizon, officials believe the demand is being met in Rochester.


While these operating spaces are relatively new, physicians emphasize that patients should feel comfortable that surgeons know what they are doing in a hybrid operating room.


"We were doing these procedures back when we had a Volkswagen, and now we've got a Ferrari. It's not like we had to learn to drive because we got the Ferrari; we were just able to do it better," Riggs says.


Kat Lynch is a Rochester Business Journal intern.


8/17/12 (c) 2012 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email


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