Allura becomes OP

Multifunctional operating theaters: one for all

Dtsch Arztebl 2011; 108 (7): A-342 / B-274 / C-274

When designing modern operating theaters, increasing importance is attached to a high degree of flexibility: as independent of the specialist field as possible, as well as minimally invasive or open surgery - the operating theater should be used multifunctionally.

The hybrid solution from Maquet combines a cardiac surgery operating room and a cardiac catheter laboratory. Photo: Maquet

Medical technological progress often starts in the operating room (OR). New treatment and diagnostic methods are often introduced and established here. The procedures are gentler and shorter for the patient, but also more precise and effective. The motivation for innovative developments in the OR is varied: on the one hand, it can be sought in the improvement of therapy options, on the other hand in the optimization of work processes and the relief of the OR staff. A higher efficiency in operative interventions can spare the burdened coffers of the clinics, but should also always benefit the well-being and the safety of the patients.

Collaboration between cardiologist and heart surgeon

Maquet GmbH has been following the trend towards multifunctionality for several years with its hybrid OR. “Maquet has virtually redefined the hybrid operating room. Our goal was to use the cardiac catheterization laboratory with its imaging capabilities for other operations as well. The merger of the cardiac surgical operating room and full-fledged cardiac catheter laboratory enables cardiologists and cardiac surgeons to work together directly in the hybrid operating room, ”explains Klaus Christian, the responsible project manager at Maquet, at the presentation of the hybrid operating room.

Maquet has installed a fully equipped version of the interdisciplinary operating room at the Surgical Academy in Rastatt. Doctors, clinic administrators and hospital planners should get a comprehensive impression of the possibilities of planning, implementation and equipment from a single source. “Our goal is to optimally adapt the room concept and the technical equipment to the workflows in the operating room. This means, for example, that when combining cardiac surgery and cardiological workplaces, it is mandatory to maintain optimal working conditions in both disciplines. The positioning of the operating table, the angiography system and the other systems are coordinated with the interdisciplinary OR team in accordance with an optimal workflow, ”says Christian.

The heart of the hybrid operating room is the combination of the Magnus operating table from Maquet and the angiography system Allura Xper FD 20 from Philips. With interchangeable and flexible modules on the operating table, the operating room lights, ceiling supply units and wall elements, the hybrid operating room can also be used across disciplines by other surgical disciplines. Philips developed the flat panel detector system specifically for vascular and cardiovascular interventions. In the hybrid operating room it is mounted on the ceiling so that it interferes with the anesthesia as little as possible. The Maquet operating table is an interchangeable top table and can be controlled using a joystick in combination with the C-arm. The C-arm automatically follows the movement of the operating table even in certain positions. This means that the X-ray device does not have to be readjusted if the patient changes position. Electronic collision protection prevents the device from getting too close to the patient.

More safety for the patient

The collaboration of doctors from different specialties, in this case cardiologists, cardiovascular and neurosurgeons, is intended to open up completely new treatment options: The spectrum ranges from interventions in vascular constrictions and prostheses to constricted valves, which are both minimal in the hybrid operating room - can be treated invasively as well as surgically. The angiography system and echocardiography enable immediate postoperative control. One example of a new treatment method that can now be implemented in the hybrid operating room is the implantation of a biological aortic valve prosthesis using a catheter: the heart valve is inserted into the heart with special catheters and anchored there. A large opening of the rib cage by cutting the sternum is therefore no longer necessary. The heart is accessed directly via the apex of the heart - through a small incision on the left side of the chest. In this method, the cardiologist who places the catheter and the heart surgeon work hand in hand.

The fully networked medical and non-medical devices in the high-tech endoscopy operating room from Olympus can be controlled via a touchscreen. Photo: Olympus

“An important advantage of this approach is the greater safety for the patient - in the event of an incident, they no longer have to be brought from the cath lab to the sterile operating room. Often the two rooms in the clinics are far apart. In the hybrid operating room, the thoracic and abdominal areas can be operated on conventionally at any time, and the risk patient no longer needs to be repositioned, ”summarizes Christian. Further advantages for the clinics would be better utilization of the operating room, as it would no longer only be used for catheter examinations. That means more profitability.

System integration all in blue

Olympus is pursuing a completely different concept for system integration in the operating theater with the Endoalpha operating theater system for endoscopic examination rooms and operating theaters. The design underlines the impression that it is a high-tech operating theater. Typical of the system are the blue glass walls and the individually controllable LED lighting design, which can also simulate a realistic impression of daylight right up to sunset indoors. This should contribute to a more pleasant atmosphere for the surgical team and enable relaxed work. In addition, thanks to a special surface treatment, the glass walls make a contribution to better hygiene in the operating room. The devices are also controlled via glass touchscreens, which are disinfected and can be operated in the sterile area.

“Medical and non-medical devices are completely networked and controllable at Endoalpha. The focus is not on individual products, but on system solutions and process optimization. This helps to save time, improve the flow of information and working conditions, and at the same time gain better results and more time for the patient, ”says Thomas Lütke-Kappenberg, head of the system integration division at Olympus Deutschland GmbH, describing the concept. It contains the modules control, video management, documentation and workplace design, which are coordinated in such a way that work processes, information management and ergonomics in the OR can be improved. When it comes to operating theater technology, the company relies on the networking of purely medical devices with non-medical devices that are controlled by Endoalpha Control via a central touchscreen. In this way, the surgeon can find a connection for his iPod, for example, which has saved the individual lighting concept, as well as his favorite music.

"The OR staff should feel comfortable," says Lütke-Kappenberg. “But in a modern operating room, design and ergonomics should also help to simplify the process flow. That is why Olympus carries out an intensive process analysis for the hospital in which Endoalpha is to be set up before developing and planning an operating theater. This creates a process model that describes the patient's path from bed to the operating room and with which the processes can be simulated. Process analyzes of this kind have already revealed, for example, that in a hospital out of twelve planned operations, only nine were necessary in the end. "

Dr. rer. nat. Lisa Kempe

Links to the solutions

  • (Hybrid ORs - Angiography)
  • (Headings: Products & Solutions / Hybrid OR)