by Jeannie Akridge
they’re called hybrid, integrated, universal, or simply "smart", these
advanced operating rooms give surgeons new flexibility by coupling
traditional surgical capabilities with the latest imaging modalities. Access
to X-ray, CT, MR and other diagnostic equipment typically found in
interventional radiology suites and cath labs can help lead to improved
outcomes as well as operating efficiencies.
According to a report by
Millennium Research Group, the OR integration market will see an average
growth of approximately 15 percent per year through 2015.1 "As they become
more popular, hybrid ORs also increase demand for new hybrid-compatible
versions of such products as surgical tables and equipment booms, while
increasing the complexity and cost of integrating devices. Growing demand
for advanced operating room equipment that can promote OR efficiency and
patient safety will be a major driver of the $2.4 billion United States
video and high-tech hardware device market," said the report.
"Over the last 5 to 7 years
integrated hybrid rooms have become more common," observed Jeff Dunkley,
director of design,
"Integration is defined as a room in which all the different equipment is
designed to work together in harmony with each another – and with the staff;
thus providing better patient care and more efficiency in those
rooms. Hybrid is defined as a room serving both diagnostic and surgical
functions in the same location."
"The challenge in making this
work successfully revolves around integrating traditional cath lab imaging
equipment with operating room equipment," Dunkley continued. "If designed
properly the integrated hybrid suite will cut costly patient transfer from
cath lab to OR then OR back to cath lab (and even a return trip from cath
lab back to OR in some cases). The patient is diagnosed, then treated, then
examined post operatively all in one location."
"We are seeing a movement
toward multidisciplinary and minimally invasive (MIS) approaches that
synergize the benefits of imaging and surgical sciences," said Robert
Popilock, senior market development manager, Surgical solutions,
Corporation. "Many hospitals are working under a paradox; to reduce
procedure times for the most challenging patients without sacrificing
service quality, while also dealing with tremendous pressure to decrease
costs and improve quality indicators such as complication and infection
rates for these types of patients. The ability to perform image-guided MIS
procedures under the safety net of a sterile environment becomes highly
"With more complex procedures
and the use of advanced imaging, the surgical suite is rapidly changing,
increasing the need to access patient data and clinical images in real time
during many surgical procedures. This has driven the integration of OR
suites into the overall hospital data and patient environment," said Walt
Hoffman, group marketing manager, Hybrid OR Therapy, MAQUET.
"And, with more complex procedures, hybrid procedures, involving several
medical specialties, each with their own equipment and imaging needs, has
given rise to the Hybrid OR, in which each specialty can perform their part
of a complex procedure in a single room using all of the products and
functions they would have in their own dedicated specialty room. All of
these specialty devices and equipment must function together seamlessly,
sometimes for the first time."
MAQUET Hybrid Vascular OR
Steve Palmer, director of
marketing, TRUMPF Medical Systems,
commented, "The definition of a hybrid room can vary dramatically, but it
essentially brings high-end imaging and surgery together in the same room so
that surgical and diagnostic procedures can be done in sequence without
delay. What we are seeing is many larger hospitals are renovating to include
at least one Hybrid OR. Common surgical specialties include Neurological,
Cardiovascular, and Electro-physiology."
"Another way to look at this
is in terms of operating suites that are flexible or universal," added
Palmer. "Because technology and surgical procedures continue to evolve
rapidly, hospitals don’t want a room that’s dedicated to one specific
discipline. They want to be able to use these rooms with as many disciplines
as possible. So, use for other disciplines is possible right now if the
rooms are planned correctly."
Matt Weismiller, president,
BERCHTOLD, described key advantages for surgical outcomes by bringing
imaging into the OR. "The surgeon can visualize the target more effectively
using imaging technology," said. "Even today, specific neurological and
cardiology procedures cannot be done without surgical imaging. As surgical
techniques continue to advance, especially non-invasive techniques, imaging
will allow surgeons to fully visualize the target and the quality of the
completed procedure without the complications associated with an open
With imaging equipment at
their fingertips, "benefits for the surgical team include the fact that
success of the procedure can be better validated before completion of the
case," said Palmer. "Also, since timeframes are condensed (by eliminating
waiting, delays and multiple procedures) so care can be delivered more
efficiently and with less staff stress and fatigue."
"For patients, the hybrid OR
can minimize the chance of a required subsequent surgery," he added. "Not
only the patient, but his or her loved ones can be spared the stress and
risk or additional procedures."
Finally, "the hospitals
benefit from faster processing times for patients. Also, improved staff
satisfaction, retention and recruitment of better surgical talent by
offering the latest most sophisticated technologies are considerable
What does it mean to have a
truly "smart" OR? What minimal functionality should it have and what type of
equipment is needed?
"A ‘smart’ OR starts with data
integration," explained Hoffman. "During a surgical procedure, the surgeon
needs access to previous patient procedures, tests, and images, while
continuously monitoring the patient’s current clinical status. This requires
the ability to access a variety of images – from x-rays to ultrasound to CT
to MR -- in both still and video formats, often simultaneously on multiple
monitors. It is not uncommon for two, four, and even eight monitors to be
displaying data from multiple sources to different medical specialties and
"All of this data must be
coordinated in order to avoid procedural delays and provide the best patient
care," he continued. "The keys to success are high-grade medical display
monitors, the ability to play and distribute multiple test results and
images from various hospital data systems, the ability to control systems to
coordinate the rapid access and switching of data sources and displays, and
cameras and computer drives that can capture data and images from the
current procedure for future review and use."
Dunkley described Berchtold’s
vision for a smart OR. "Creating a ‘smart’ OR would involve bringing digital
technology and control to the surgical suite – and to the surgical table if
requested. The circulating nurse can monitor and, in some cases control, the
various surgical modalities from a conveniently located control station
within the room. That control/nursing station would use touch screen panel
technology, thereby greatly reducing or completely eliminating their need to
physically locate and touch pumps, insufflators, light sources, camera
controls, etc. The ‘smart’ OR has all been integrated and wired together
through the ceiling and boom arms in order to work in harmony. Additionally,
a versatile touch screen monitor can be located from the ceiling and, after
being sterilely wrapped, conveniently positioned for the surgeon – thereby
allowing them direct control of these devices from the surgical table. If
this ‘smart’ room is designed properly it can save and create enough time to
do one extra case per room per day. There is a tremendous increase in
revenue and ROI derived from that," he added.
Popilock, STERIS, contended,
"If we define a ‘truly smart’ OR as one that enhances decision-making
confidence, improves procedural efficiency and creates a safer, more
efficient environment, then it is essential to have an ideal marriage of
fixed and portable imaging equipment such as c-arms, traditional surgical
devices, and optimal surgical lighting. To make it completely smart requires
the addition of an integration system capable of routing essential
information (live and reference fluoroscopy, endoscopy, HD surgical field
cameras, TEE, vitals, hemodynamics, etc.) to any location within the room in
user-defined single and multi-image formats."
According to Melissa King,
senior marketing associate, Integration,
"A truly ‘smart’ surgical suite would be equipped with an integration
control system, a digital capture device, and a boom for dedicated medical
equipment. In a ‘smart’ OR it is essential to have the ability to control
all of the video signals and audio throughout the room as well as the
medical devices located in the room, for instance the Endo camera, the
insufflator, and the surgical lights, all from a centralized touch panel via
an intuitive user interface. The ability to conference throughout the
hospital and abroad is essential as well. The boom assists in cable
management in the OR as well as supports OR workflow and efficiency."
Stryker/Philips hybrid OR
Stryker recently introduced a
new high-definition monitor, the WiSe HDTV Flat Panel Monitor, the first
wireless 1080p flat panel in the medical field, described King.
"Uncompressed HD is transmitted wirelessly to eliminate cable clutter and
potential costly repairs to traditional flat panels. WiSe HDTV will deliver
optimal surgical images with unsurpassed resolution, brightness, and optical
clarity while providing freedom to move the flat panel anywhere within the
OR. The 1288 HD, Stryker’s third generation high definition 3-Chip camera,
delivers an unsurpassed 1080p resolution with optimum depth of focus, and
edge-to-edge clarity and sharpness for surgeons. It also features an
intuitive touch screen, fully programmable camera head buttons and the
ability to control the L9000 LED Light source from the camera head."
Jeff Saunders, project
engineer, TRUMPF, described minimum requirements for an integrated OR to
include: "at least three lights, an equipment boom, a monitor boom. The
trend for the monitor is to have one large (54" screen) where the staff can
divide the screen as required: i.e. if the surgeon only wants to see 2
images the screen is split in half, if the surgeon wants to see 4 images,
then the screen splits into quadrants."
According to Palmer, imaging
components of a hybrid OR include floor and ceiling mounted C-arms, MRI, and
Bringing imaging, video, data
capture capabilities and more into the traditional OR environment requires
seamless integration of a variety of equipment.
David Church, boom & lights
product manager, for Stryker, commented, "Advanced operating suites today
are moving towards being fully integrated in order to support the complexity
of advanced surgical procedures. By integrating the various components of
the operating room, users can operate these components from a single
interface increasing efficiency. This integration is crucial with hybrid ORs
as hospitals see these suites as a solution to constraints on space, as well
as the need for an environment which fosters the ability to create new ways
of performing complex procedures."
"The primary objectives of
integration are to improve decision making, align the surgical team to
better anticipate procedure needs and drive efficiency, and to create a less
stressful environment," described Popilock. "This is accomplished through
making mission-critical information available table-side for physician
viewing, room wide for surgical team viewing, and remotely for education and
peer support. The ability to integrate music can also create a more pleasant
Integration systems that are
based on an open architecture format offer maximum flexibility for future
"Open architecture means that
you are prepared to implement any future technology from any viable source,"
Dunkley explained. "Just because you’ve chosen a certain manufacturer, and
their technology today, does not necessarily mean that you will want to
choose that same manufacturer and their technology five years from now."
STERIS Harmony iQ
Harmony IQ systems from STERIS
are scalable, open architecture multi-format integration systems capable of
concurrently routing a diverse set of signals in their native and
high-definition formats to a variety of small, large, and whole wall
displays, described Popilock. "This functionality is available at the time
of purchase or through field upgrades that do not require rebuilding of the
Stryker’s SwitchPoint Infinity
3 Control System (SPI3) features an integrated surgical checklist,
customizable room presets, and centralized operating room control.
"Hospitals also have the ability to bridge the distance between sites across
campus or locations abroad via the integrated ConnectSuite IP conferencing
platform," said King.
MAQUET’s OR integration system
allows data and images in all commonly used formats (e.g., HD-SDI, CVBS and
VGA) from up to 12 sources to be displayed on up to six monitors
simultaneously. At the same time, the system saves images from the current
procedure, either with DVD or USB drives or in standard DICOM formats, to
the hospital’s PACs system, Hoffman explained. "The MAQUET OR Integration
system is compatible with a hospital’s existing LAN and internet networks,
even allowing transmission of live cases to doctors’ offices or to training
centers. These capabilities are all controlled through an intuitive touch
screen that is easily and readily accessed by the OR staff and that is also
used to control OR room lights, Magnus table position, and other accessories
commonly seen in the OR."
"Most importantly, the MAQUET
OR Integration System is upgradeable so additional features, displays, and
storage systems can be added as surgical procedures continue to evolve at a
rapid pace with new, unforeseen demands," explained Hoffman.
management systems, commonly known as "booms" are the physical strongholds
that house the ever-growing equipment needs in the advanced OR. They keep
equipment and cables out of the way and off the floor, and feature moveable
arms that allow for flexible positioning within the room. Newer boom systems
allow for a great deal of versatility and modularity to accommodate changing
"In a ‘smart’ OR, anesthesia,
perfusion, endoscopy, surgical headlights, and other critical equipment can
be housed on supply heads and equipment management systems that can be
easily and conveniently located by the circulating nurse – allowing
equipment to be brought in and out of play as needed." described Popilock of
the benefits of the STERIS Harmony Equipment Management System.
"Today’s operating room
environment is one of fast paced technological change. For an institution to
maximize their return on investment, OR booms must provide the flexibility
to meet that change," said Rollie Kitchens, global TELETOM product manager
for BERCHTOLD. "Berchtold’s latest generation of the TELETOM Equipment
Management System does exactly that in a number of ways. First, the system
is entirely modular. Berchtold’s OR booms can be configured to meet the
exact needs of the hybrid operating room today, service placements can be
easily adapted if the need develops, and if future technology dictates the
need for additional capability, TELETOM can be readily re-configured to meet
the change. Depending on the needs of the institution, that may
translate into adding a layer to the existing boom in order to gain
additional service capacity, attaching additional monitors to support
increasing video needs, or gaining more lighting capability. The new line of
TELETOM OR booms adapts quickly and cost-efficiently due to the
unique, highly flexible, modular design of the boom and its equally
flexible, optional TC-ready suspension system. Making additions to
the system doesn’t require gaining access above the ceiling, or making
changes to the ceiling mount which translates into minimizing OR down time,
and the associated loss in revenue."
MAQUET’s Ceiling Supply Units
(CSUs) extend to nearly 8 feet to allow for versatile positioning of
equipment, noted Hoffman. "With many different medical specialties utilizing
a Hybrid OR suite, it’s critical that equipment be readily available when
needed by a particular surgeon and that it be out of the way when not
"With more OR staff supporting
different specialties, the ability to easily to move instruments and
equipment in crowded OR speeds the surgical procedure," Hoffman added. "CSUs
are ideal for fast deployment while eliminating power cords and cables from
the OR room floor. This facilitates cleaning, leading to faster OR room
turnover, less delay between cases, and a better overall return on the smart
OR room investment."
Church, Stryker, noted, "In a
Hybrid OR environment, there is a great need for monitor, boom and lighting
mounting solutions that work in conjunction with the imaging systems. Larger
room dimensions, filled with a considerable amount of equipment, create a
challenge for management solutions to have the capacity and modularity for a
variety of needs."
Stryker’s FLEXiS boom systems
feature a six-sided design that allows for supply of additional
gas/video/data services in a smaller footprint; multi-functional rails that
allow for adjustability and numerous placement possibilities for shelves and
accessories; and various service head sizes and boom arm length options,
surgical suite at Kennedy Medical Center, Washington Township, NJ
TRUMPF’s TruPort allows all
sides and the entire length of the support head to be used and easily
customized to meet specific staff and patient needs on a case-by-case basis,
and offers modularity to accommodate future processes, procedures and
technologies, described Palmer. "Do-it-yourself" simplicity helps improve
ergonomics, while reducing service calls, operating room downtime and
In addition to supporting any
laparoscopic or endoscopic equipment required during a procedure and serving
as the primary source of providing medical gas and electrical support to the
surgical field, "the greatest benefit to TruPort in the hybrid environment
is the ease at which we can change the configuration to support new
equipment and procedures," said Saunders. "As these rooms become more common
place, the spectrum of procedures performed in these rooms will grow. Having
equipment that can easily accommodate advancements in technology and diverse
procedures is essential."
forward suite design
Diligent pre-planning is
paramount to creating a surgical suite that not only works for today but can
also quickly adopt to accommodate new surgical techniques and modalities.
"An eye should always be kept
on what new technology is coming around the corner. Because your hospital
may be forced to adapt to it in the near future in order to remain competent
and competitive," said Dunkley. "Insure that all of your vendor partners are
on that same future proofing and open architecture page. The hospital does
not want to paint themselves into a fatal technology corner today, in order
to merely adhere to the old bundling and contract compliant concepts of
"We understand that the only
constant in the ‘smart’ or hybrid OR is change," he added.
"The science of smart surgical
suites is in its adolescence," remarked Popilock, STERIS, The most
significant advancements will be based on sound end-user insights. For this
reason, it is essential for industry professionals and their clinical
partners to forge strong relationships and maintain communication about
initial experiences, existing challenges, and key clinical drivers. If we
understand their in-use cases and the insights behind them, we can evolve in
more meaningful ways."
Imaging technology is one area
that’s sure to advance, noted Weismiller. "Many of today’s imaging devices
are excellent for use in the OR, and will continue to improve as the
requirements for new procedures are better understood. But much of today’s
imaging technology was developed for diagnostics, as opposed to
interventional processes. The future holds smaller and lighter systems with
even better performance that will work effectively in an interventional
setting with a surgical team. Today, the physical hybrid OR and the workflow
are driven primarily by the imaging device; in the future the imaging device
must be tightly integrated into the process and the surgical environment."
complementary imaging technologies such as Siemens, Philips, GE Healthcare
and others, have partnered with surgical suite vendors to offer "package"
integrated hybrid OR solutions.
"To avoid incompatibility
between equipment from different sources, hospitals should partner with
manufacturers that can offer systems that are as complete as possible,"
advised Hoffman. "When hospitals must work with different manufacturers,
they should choose companies that have established partnerships with each
other, even to the point of offering a single construction project price and
integrated drawings and design."
pre-fabricated room systems offer an innovative approach to future proofing
an OR suite.
For example, MAQUET’s
customizable VARIOP system offers pre-fabricated wall components, windows
and doors, and floor and ceiling panels, reducing construction time. "VARIOP
represents a unique construction approach to the ‘smart surgical suite,’
offering all the components to design and construct the OR room itself,"
said Hoffman. "The panel design, provides access to electrical, medical gas,
and cabling systems without the need for tools. And the sealed panels
facilitate cleaning, making room turnover quick and efficient."
"The TRUMPF ModuBuild medical
construction system, offers efficient, flexible room construction, using
integrated components including the substructure; walls; ceiling, windows,
doors and ventilation connections," said Palmer. "In addition to
streamlining construction and significant hygienic benefits, ModuBuild
serves to help future proof the OR. Its modular stainless steel panels –
powder coated to the hospital’s color of choice - allow easy access inside
the walls. This allows service, modifications and future changes in
equipment and wiring, including upgrades and expansions, to be accomplished
quickly and cleanly."
Ultimately, an investment in
advanced surgical suite technology makes good business sense, concluded
Church, Stryker. "An advanced hybrid OR suite can help to recruit top-notch
surgeons and help to market the hospital to potential patients, so
successful implementation is imperative. Hospitals will obviously need to
identify an imaging system, boom and lighting solutions that work with, and
around, the imaging system and integration equipment that is robust enough
to grow with the needs of the OR. However, hospitals should also keep in
mind that it is not only the equipment that ensures success of the project.
Experience in room design and implementation of other advanced surgical
suites is also a benefit to this process. Vendors that have this experience
are more able to mitigate the risk of potential issues and help ensure the
successful completion of a hybrid OR design project."
1. Millennium Research Group,
"US Markets for Video and High-Tech Hardware Devices 2011", May 2011.