This article appeared in the April issue of  Surgical Products.

The integrated or hybrid operating room is changing the way surgery is performed and medicine is practiced in hospitals and medical facilities across the country. Surgical Products reached out to three different experts to discuss how technological developments in the operating room have improved efficiency, altered how surgeons and other OR staff approach their jobs, and what we can expect to see in the future. 

The effects OR integration has had on a surgeon’s day-to-day responsibilities:  

Dr. Ron von Jako, Chief Medical Officer, GE Healthcare: Many of the technologies that are now in hybrid or integrated operating rooms make it a new environment for many surgeons. Some training is going to be required for them, and in some cases some of the medical school curriculums today may be updated to start to train surgeons, medical students, or residents going into surgery on how to interpret radiological images, for example.

Chris Irwin, Senior Project Manager, Skytron: The effects have been very positive. Video sources, archived information, patient monitoring, and other key information can easily be routed into the surgical field for surgeon’s access. Eliminating the need for surgeon to leave the surgical field to access the information could lead to delays in surgery. A surgeon that has access to pertinent information past and present can expect better patient outcomes. Areas of new technology like robotic devices and high-end imaging help hybrid ORs benefit to a higher degree with the addition of OR Integration since these rooms generally have more video sources and information to route into the surgical field.

Jens Ruppert, Vice President and General Manager, Surgical Business Unit, NDS Surgical Imaging: The integration of an operating room can have a measurable impact on how a surgeon does his or her job, providing instant access to clinically relevant video information and improving staff workflow. With an integrated OR, multiple image and information sources can be managed quickly and brought into the surgeon’s field of view. It makes sense that a surgeon can make more informed decisions on any given case when they themselves are better informed.

How the integrated OR has improved efficiency:

Bill Jacques, VP of Global Marketing, Berchtold: There is a lot of patient information and imaging information that is starting to flow through the integrated OR. In addition, you are seeing equipment information and overall room control as part of that. It has really migrated from what was initially the value of video information to much more, which reduces the time it takes to make decisions in the OR. Now you can start to correlate that information available with the potential to improve outcomes. You can get a lot of that imaging information to confirm that the procedure has been done appropriately – particularly in a hybrid OR. There are studies that now support that.

Irwin: Information pertinent to the specific patient or surgical procedure can be accessed and routed in seconds, greatly reducing the time needed to locate this information. It can be visualized by the surgical staff on HD quality displays that greatly enhance the viewing. Total access to any information needed and greatly enhanced visibility.

Ruppert: A well-designed integrated OR brings all relevant information to the surgeon in seconds.   Routing of live operative information, such as c-arm images, IVUS, patient vitals, endoscopic video and comparative images can occur immediately when a surgical team member inputs a few simple commands on a touch screen interface. The days of tracking down x-ray film, waiting for someone to delivery pathology results or other clinical information from elsewhere in the hospital effectively end with a carefully planned integrated OR. 
One of surgeon’s greatest frustrations is having to wait.  Delays in the case set up, the readiness of the patient, and more importantly, waiting for the tools that enable a surgeon to perform the procedure, can all contribute to poor workflow and a potentially adverse effect on the outcome. Also, for the modern hospital facility, time lost is revenue lost.  Operational efficiency of the room is imperative, from set up, through surgical procedure, to cleaning and turnaround.  OR integration helps streamline the entire process.
Where the technology is headed in the future:

von Jako: I don’t think we’ve realized the full potential of the hybrid OR in terms of information flow and image flow. I think they are realizing some benefits, but I think they initially overshot it in terms of how much they could take on right away given how much information was available throughout their system. Teaching institutions tend to lean toward going to a more high-end system, because they route the information outside toward other groups of people. But for non-teaching institutions, I think they’ve kind of hit a steady state. That’s just my perception.

I think what we’re looking at is everything to be plugged into the network and everything can be served up on the network for each and every user. That’s the end game. It’s big in cardiovascular surgery today, and it’s going to go beyond that in the future. In thoracic surgery, with those surgeons moving back toward the less-invasive surgeries, I think it’s going to expand in that area. Then on the laparoscopic side of things, you have general surgeons who are already integrated into it.  I think there are also some other integrations that are going to be part of this. It’s not just for the urologists and gynecologists working on soft-tissue surgeries, but they’ll introduce ultrasound images to be able to better visualize some of the masses that you wouldn’t be able to visualize so easily with an endoscope from the surface. You can look into the mass beyond the surface with ultrasound technology, which is less invasive than using CT in some cases. There will be a lot of integration continuing with the different imaging modalities to try to make these procedures as less invasive as possible.

Irwin: Smart devices managing information access and visual information securely within the healthcare space. Surgical Timeout and multimodality imaging with even greater resolution, 3D imaging and procedural archiving which seamlessly merge the entire patient experience.
Also, it will be possible to safely archive and share captured information both still and video for immediate and future reference. state. That’s just my perception.

The “must-have” technology right now:

Jacques: Many facilities are still working on the financial justification, and so quite often they look at the hybrid OR and say what procedures can take place in that operating room that make the best utilization of that capital investment. To get there, many facilities start to think of the OR as a multi-purpose room. It’s not dedicated to one type of procedure. For us the implication is we need to design flexibility into that operating room. That’s what we do. We mount things into the ceiling so everything can be repositioned based on the surgeon’s operating hand or which side of the table he or she operates from, also what kind of imaging equipment may come in or out of that room. For us, it’s all about enabling that room to be flexible and ensure the information that’s being collected routes to the right place and to the right line of sight for the surgeon.

von Jako: None of these technologies are cheap. To build a simple integrated operating room, most of them are around 650 square feet or more, and if you move toward adding in monitors and ceiling-mounted monitors, the renovation could be $1.5 million for some of these rooms, plus whatever technology you put into it could be another $1.5 million. These rooms, depending on the needs and specialties that are going to operate in it, can range anywhere from $3 million up to even $25 million. Facilities also need to have the space to do this. Do they have the resources? Do they have the technical people skills to be able to manage one if they did build one? Would they have to recruit people to come in and train people? Then what specialty is going to operate in it? Facilities have to look at their ROI and how quickly they can recover some of the cost.  The planning that goes into these can take a year or two. Nevertheless, these are popular environments that are mainly driven by imaging and information technologies and can be utilized around the clock for less invasive procedures commonly shared with various interventionalists including; cardiologists, radiologists, electrophysiologists, neuroradiologists, and pediatric cardiologists, endoscopists, and now cardiovascular and other surgeon subspecialties surgeon.

Irwin: Fiber cabling can offer may benefits to installation and transmission of quality images. System (Touch Panel) must be user friendly for staff to operate quickly and easily for access and routing of information. The OR is becoming more technical in nature every day and simplicity and ease of operation is a “must.” Fiber optic based integration solutions offer flexibility of inputs and outputs to aid in the workflow of the operating room. Fiber optic cabling also provides bandwidth to accommodate the technology currently found in the OR today and the technology being developed for release in to the healthcare market in the future. The infrastructure allows for greater transmission distance of video signals and is not subject to loss or noise, which can be disruptive during surgical procedures.

Ruppert: A network interface between the OR and the hospital servers instantly connects other departments via the hospital LAN.  The pathology lab, ICU, MRI and other rooms are readily accessible to stream images and patient data, reducing the surgeon’s “waiting game” for vital information. Even though little documentation exists on how influential an integrated OR is in improving the outcomes of a procedure, it is apparent to everyone vested in the patient’s well being that having this amount of information available is invaluable.

Live streaming over secure IP networks also allows medical professionals around the world to be connected during procedures, furthering critical education and training.  By recording the streaming video, surgeons can refer to the procedure later, and improve communication with the patient.

The need for the efficiencies provided by an integrated operating room will only multiply in years to come.   The 76 million baby boomers, born between 1946 and 1964, have entered the point in their lives where surgical procedures will become more prevalent.   IData Research noted that by 2016 over 50 percent of ORs will be integrated, however many clinicians feel that this number needs to increase in order to keep up with shrinking surgical staffs and increased demand for surgical procedures.