Solving vascular problems cohesively and efficiently.
A single table sits in the middle of the spacious 800-square-foot room. At its head is a myriad of flat panel screens to assist in the doctors’ procedures. Surgical supplies line the walls of one corner, while a computer desk occupies another. Except for the translucent green glow that creates a virtual crown molding of light around the ceiling’s edge, most outsiders would think it’s just another operating room. Nevertheless, the new “Hybrid Operating Room” at Barnes-Jewish Hospital is an innovation in cardiac and vascular surgery and intervention. By providing the space and equipment needed to accommodate multiple specialties in one room, it allows for better quality of care as well as better time and cost efficiency for the patient.
The best treatment for many cardiovascular patients often engages both surgical and interventional specialists. Unlike traditional surgery, interventional procedures involve catheters to open blood pathways for diagnostic tests or to repair damaged structures. For instance, a patient with a critical narrowing of an artery to the brain and chest and a narrowing of the same artery in the neck can make for a very complex clinical situation. Surgical teams need the necessary equipment and support to remove the plaque in the neck via endarterectomy, while the interventional cardiology team needs access to the chest.
Bringing it all together
The Hybrid OR is the size of two regular operating rooms in Barnes-Jewish’s Cardiothoracic OR. It was built so that both vascular and cardiac surgeons and interventionalists can work in a single room. Physicians can perform advanced hybrid therapies such as conventional, catheter-based and less invasive surgical procedures, and they can streamline care for patients who need multiple procedures as part of their treatment.
“It really brings the best of both worlds of cardiac surgery and vascular medicine together in one room,” says Colleen Becker, RN, director of perioperative services at Barnes-Jewish Hospital.
In the traditional treatment model, interventional procedures were done in separate rooms from medical imaging, which was done in separate rooms from surgeries. Often, the catheterization or imaging rooms were far away from the operating rooms. That meant trouble for patients undergoing minimally invasive procedures who took dramatic turns for the worse and required open surgeries.
“While some procedures can be done in cardiac catheterization labs, that’s not a surgical environment with the same type of sterile environment. So to bring the collaborative care into this area is innovative,” says Becker. “If we need to convert to surgery for a full surgical case, we can do that as all of the staff, equipment, materials and supplies are present.”
The new layout also allows certain patients to have a same-day, one-stop process, such as a cardiac catheterization to check coronary arteries before planned valve surgeries or a hybrid stent procedure and valve surgery. The combination of services will lead to more efficient, safer procedures for patients, such as valve interventions without open heart surgery or cardiovascular bypass.
Advances in treatment
The Hybrid OR is distinguished by a green light running across the top of the walls. It helps with one of the room’s innovations in fixed fluoroscopy, imaging providing real-time, moving radiologic images.
“That means we can get very definitive images of blood vessels, heart valves, parts of the heart and parts of the patients’ vessels all through their abdomen, legs or neck,” says Becker. “Physicians can get a much clearer, more definitive image of what they’re looking at and can do diagnosis and treatment together in that room.”
Also, more minimally invasive procedures can be performed in the room. Intravascular ultrasound, angiography, dynamic CT imaging, and other imaging technologies are available from a custom-designed imaging system on a robotic arm.
“For example, abdominal aneurysm repairs in the past were large procedures with open incisions. Now it’s done through a needle stick in an artery at the top of the leg,” says Becker. “This room allows patients to have the same procedure, only much less invasively.” Some cardiac valve replacement surgeries can also be performed with a minimally invasive approach in this operative suite.
It’s estimated the Hybrid OR will see about 350 cases annually.
The Hybrid OR is the final piece of the nation’s largest operating room renovation project, which began in 2005. The $110 million project also included the installation of the intraoperative MRI suites, giving Barnes-Jewish and Washington University neurosurgeons the most advanced operating room imaging technology in the world. The IMRI machines allow for real-time images of the patient’s brain inside the operating room instead of having to wait until after surgery and risking the need for additional medical treatments. Surgeons can also videoconference and consult with other physicians worldwide while performing the procedures. At the time of installation, only three other facilities in the world had the IMRI technology.