By Bruce Landau RT (R) ARRT

As new surgical endovascular procedures increase, anesthesiologists, cardiologists, cardiac, neuro and vascular surgeons are requiring and enjoying a new idea in optimizing patient care, the hybrid operating room (OR).

In late 2003, the Hospital of the University of Pennsylvania (HUP) in Philadelphia, PA, started pursuing the idea of building a hybrid OR. In January of 2005, HUP open its first hybrid OR, one of the first in this area. The second hybrid OR opened in January of 2010 (see Fig. 1).

Figure 1. Hybrid operating room at the Hospital of the University of Pennsylvania in Philadelphia. Courtesy of Patrick Wilson

My role in the design, construction, and operational phases was a valuable experience and an exciting journey in a new way to care for patients. Today, as lead radiologic technologist, I am assigned to Penn Vascular Surgery and in charge of the daily imaging operations of 2 hybrid OR.

So what is a hybrid OR? Simply, the hybrid OR is the merging of a regular operating room with sophisticated radiological imaging “Xray” machine. These systems are not fixed to the wall like old Xray machines.  They are mobile and free moving and can rotate around the patient to allow the surgeon better angles to view the patient’s blood vessels.  For the patient, the major benefit of the hybrid OR is that it is a multi-procedural room allowing for non invasive catheter based procedures to be performed with state-of-the-art imaging equipment and the safety of full surgical backup should the need to convert to an open surgical procedure ever arise. That is this equipment is IN the Operating Room so if there is a problem then emergency surgery can commence immediately on the same table in the same setting saving valuable time.  This combination gives the greatest patient care, safety, and best possible surgical outcome.

Advances in digital radiologic imaging systems have new features that allow the operator to monitor and manage patient radiation dose. Today’s digital technology gives the surgeon quality, high definition images. In years past, portable c-arm fluoroscopy was used with advanced endovascular surgical procedures. The image quality was poor, as a result, increasing fluoroscopic time and radiation to patients.  Because of the increased fluoro time, portable c-arms would over heat and would have to be switched out for a new c-arm. This created a patient safety issue. Hybrid OR imaging systems have superior quality images and dose management systems which help decrease radiation exposure times, reducing patient and physician dose (even the doctors and the other staff in the room are subjected to less scatter radiation from the device. Imaging systems in the hybrid OR also are equipped with a cooling system to prevent overheating.

Figure 2. Tableside monitors in a hybrid operating room at the Hospital of the University of Pennsylvania in Philadelphia. Courtesy of Patrick Wilson.

At HUP the development of a bank of monitors (see Fig. 2) that can be moved table side, gives the surgeon a wide variety of information from many sources. This feature routes to monitors such data as patient vital signs, live fluoroscopy images, digital subtraction angiography (DSA), 3-D rotational angiography, computed tomography (CT), 3-D reconstructed images, intravascular ultrasound (IVUS), intracardiac- echocardiography(ICE), transesophageal echocardiogram(TEE), and online patient charting and reports. All of these diagnostic real time studies are performed in the hybrid OR during the surgical procedure. This is a direct benefit to patients because it optimizes patient care during a hybrid OR procedure by putting into the hands of the surgeon every conceivable piece of information about their patient in a tableside presentation.

In addition to minimally invasive stroke surgery, there are many other applications to this technology for general surgery, spine surgery, and cardiovascular surgery.

Procedures most commonly performed in the hybrid OR are:

• Abdominal Endovascular Aneurysm Repair (EVAR)
• Cerebral Arteriogram for Aneurysm Treatment and Intracranial occlusive disease
• Kyphoplasty
• Hybrid Aortic Arch Procedure
• Hybrid Aortic Valve/Peripheral Component Interconnect (PCI)
• Hybrid Catheter/Thoracic “MAZE” for Atrial Fibrillation
• Hybrid Coronary Artery Bypass Graft (CABG) with Angiography
• Percutaneous Carotid Angioplasty
• Percutaneous Cardiac Intervention
• Percutaneous Left Ventricular Assist Device (LVAD)
• Peripheral Vascular Procedures
• Inferior Vena Cava (IVC) Filter Placement and Retrieval
• Thoracic Endovascular Aneurysm Repair (TEVAR)
• Trans-catheter Aortic Valves (TAVI)

It should not be hard today to find a hospital close by that has a hybrid operating room. In a 2010 survey performed by the Advisory Board Company, the number one most requested hospital technology insight project was the hybrid OR. In the same survey, the percentage of hospitals nationally with hybrid ORs was just over 50 percent (see Table 1)

Table 1: Percentage of hospital with a hybrid OR. Source: Advisory Board research and analysis

Within the Mercer County area The Capital Health System’s new hospital in Hopewell, NJ has a hybrid OR. The University Medical Center at Princeton will be opening a new hospital this May, 2012 in Plainsboro, NJ with a new hybrid OR and a new revolutionary idea. Not only will a new hybrid OR be built, the cardiology catheterization lab and the interventional radiology suite will be located in the operating room.  This will centralize endovascular and catheter based supplies, give them the ability to cross train staff, and have OR and recovery room staff available in one location. This concept is truly the next level of development in hybrid OR design.

St. Mary Medical Center has recently opened a new hybrid OR for stroke and neurovascular patients as well as minimally invasive spine surgery.  St Mary medical Center is the only Bucks County hospital that has been designated a primary stroke center.

If you would like more information about hybrid ORs, please contact me at my e-mail address at Bruce Landau RT (R) ARRT

“Don’t be a fool!”  Mark McLaughlin, MD

Dear Patients and Colleagues,

Bruce Landau RT (R) ARRT

I am happy to introduce our interventional radiology colleague, Mr. Bruce Landau who I have known for many years and consider the best in the business when it comes to radiation technology.  Bruce, like many radiation technologists, has dedicated his career to perfecting and honing his skills to master the equipment and the delivery of image guidance in the operating room to help surgeons better care for their patients.  The Radiation Technologist is an integral part of the operating team in many surgical procedures.  My former chairman at the University of Pittsburgh, L. Dade Lunsford, once pronounced that the success of certain highly technical image guided procedures in the Operating Room depended not as much on the surgeon, but on how good the Radiation Technologist was in that theatre.  When I used to work with Bruce years ago at St. Francis Medical Center, I always was comforted to know that he was in my room, because I knew he would ensure that our case went smoothly and that our patient was going to get the very best imaging.

I have asked Bruce to write as a guest blogger for PBSC and to help educate our patients about some of the cutting edge minimally invasive neurosurgical procedures we use for the treatment of stroke and aneurysms.  This technology has revolutionized the way we care for our neurovascular patients.  Mr. Landau’s article describes his involvement in the conception, design, and implementation of one of the strongest Interventional Vascular Centers in the world at the University of Pennsylvania.

The physicians at Princeton Brain and Spine Care frequently collaborate with UPenn’s center of excellence and are pleased to present you with this blog.

Mark R. McLaughlin, MD
Princeton
March 26, 2012

As our own Dr. Shah helped spearhead this symposium event, Dr. Shah was interviewed for the Parks & Recreation magazine article. You can read a text reprint of the article and Dr. Shah’s comments here, or click here to view the magazine on line.

The award was presented on February 4th, 2012. We are indeed proud to see Dr. Shah so honored.

Dr. Shah and family with Bucks County Congressman Micheal Fitzpatrick

Dr. Shah and wife Neha are all smiles after this important recognition

Maria’s Story

“I have an appointment with a neurosurgeon in the Princeton office.  I am in pain.  My back hurts and at times my hands tingle and get numb.  I often get headaches.  Other times, I cannot describe how I feel or what I do not feel.  I walk in, and I feel my heart thumping in my throat.  I walk up to the front window and a soothing voice asks me for my paperwork.  I have not completed everything, but she tells me that she will come out and help me.  I sit by the waterfall, and I look around at the other people .. some with walkers, a young man on a stretcher, a woman crying, and I catch a glimpse of the painting on the wall.  I think .. could this be a neurosurgeon’s office, a doctor’s office, where patients get treated?  The sound of the waterfall makes the thumping in my throat cease, and as I look at the painting across the way, I think of the layers of my life that got me to this place.  I am brought back for a moment when someone asks me if I would like something to drink, or perhaps a cookie.  I think to myself .. if I need to come again, I know that I will at least feel very special here in this place.  It is now my turn to see the doctor.  I go through the door, and my breath stops for a minute as I notice two paintings side by side.  Are they signs of the mountains that I will climb when I get better? My eyes catch a glimpse of “Care” on a spine – this will certainly give me the crutch I need.  And if I need to walk in the cold snows of pain, should I be struck with a tumor, I will not fall for I will come here and have many hands to help me heal.  As I am lead to the Exam Room, I notice the colorful landscapes of hope, of nature’s wonder, and as I wait for the doctor, I think to myself that there is a plan for the kindness of the people, for the waterfall, and the art.  It is the first step towards my healing.”

I’m proud to be a part of the team here
Barbara

This new blog is dedicated to increasing patient knowledge, and to helping patients make informed healthcare decisions.

Over the upcoming weeks and months, I invite you to “drop in” and see what’s happening at the practice. In particular, I will be writing about some of the exciting innovations in concussion care and brain injury screening that are taking place at PBSC.

As we expand our patient education features and services, we felt that a blog was the perfect vehicle to keep our friends and family up to date on the latest in care, and the happenings around the practice.

We hope you enjoy the blog, and if you have suggestions or comments we invite you to join the conversation.

Sincerely

Mark R. McLaughlin, M.D.
on behalf of

The Physicians of Princeton Brain & Spine Care