Hybrid Operating Rooms – A Must-Have

For such a recent technological innovation, the hybrid operating room has quickly become a must-have concept for surgeons and hospitals around the world. It is anticipated that 75 percent of cardiovascular surgeons will be working in hybrid operating suites by 2018.

Anybody familiar with the technology will not struggle to understand why. A recent case study may be cited. A patient recently was undergoing surgery to remove the lead of their pacemaker, which had become dangerously attached to the vein with scar tissue. During the minimally invasive procedure, the team reached a point where their catheter-guided laser was unable to cut through the wire. What could they do?

Under normal circumstances, the team would have stopped the procedure and invited another group into the operating room to commence open surgery but, taking advantage of the facets of a hybrid operating room meant, in this case, that this was avoided. Instead, they were able to call in an invasive radiology team from the floor below to snare the catheter’ from another position.

Imaging equipment – from ultrasound to endoscopes – may have been used in operating rooms for years, but with complex, high-risk, minimally invasive surgical procedures such as the one the team carried out here, the benefits of having high-powered visualization equipment are obvious.

They were able to work it loose by the interventional radiology and electrophysiology teams pulling back and forth, and they finally broke the lead free without any complications. It was an incredibly elegant level of teamwork.

On top of advanced imaging equipment, hybrid operating rooms also offer the ability to transition from minimally invasive procedures to open surgery, if the situation calls for it. This brings a number of major benefits. Sometimes, during or as a result of these minimally invasive interventions, the doctor will conclude that surgical intervention is necessary. In the past, when an issue with the clogging of coronary arteries crept in, for example, usually the patient had to go for a bypass and have a surgical operation to open his chest. The good thing about the hybrid lab is that the surgeon is basically able to offer different treatments to the same patient, at the same moment in time, and in the same environment.

It is a win-win situation, about being able to follow a patient from one station to the next and about the cost of delivering that treatment – that doing something in one environment is a big advantage not only for the patient, but for the healthcare system and for those paying for that system as well.

Global Market
The global operating room equipment market is anticipated to grow from USD 4100 million in 2016 to USD 10,346 million by 2022, at a CAGR of 16.85 percent. A significant trend that will impel the prospects for growth in this market is the rising popularity of hybrid ORs. Recently, it has been observed that the number of hybrid ORs in healthcare facilities has increased globally. These ORs consist of surgical tools and equipment along with advanced imaging equipment. Since they offer a sterile OR environment, surgeons can perform surgeries, both open surgeries and MI procedures, with ease. The ability of these ORs to reduce the total healthcare expenditure, enhance patient safety, and minimize the time taken to perform surgeries will lead to its increased popularity in the fields of neurosurgery, cardiology, and orthopedics.

Factors such as the presence of several major healthcare institutions and increased investment in R&D will propel the demand for advanced and hybrid OR equipment over the next 5 years. The global OR market has tremendous growth potential owing to the recent increase in the number of surgeries being performed in different countries. As a few vendors dominate this marketplace, the level of competition is very intense. Vendors that have the capability to develop highly specialized and technologically advanced products are expected to gain a competitive edge over their peers.

Operating Tables. The growing popularity of hybrid operating tables is one of the upcoming trends that is expected to bolster this market’s growth prospects over the next 4 years, and is expected to generate revenues of over USD 1.1 billion by 2020. Due to the evolution of surgical procedures, the need for different types of operating tables has also increased. The prospects for growth in this market segment are further propelled by the increasing number of complex surgeries, which in turn has resulted in the development and adoption of technologically advanced and ergonomically designed operating tables.

OT Lights. Technological advancements have eminently transformed the OT lights market over the years, and will continue to do so in future. By 2020, the global OT lights market is estimated to reach USD 729 million, enduring with a 4.6 percent CAGR from USD 607 million in 2016. Innovations, along with technological advancements are some of the key drivers of the market. Moreover, factors such as rising number of surgeries and increasing aging population are driving the demand for OT lights. In order to improve energy efficiency and reduce greenhouse gas emissions from healthcare devices, government agencies and healthcare organizations worldwide are undertaking various initiatives to design advanced surgical lamp devices for healthcare organizations. Increasing use of LED technology is a popular trend that has been observed in the OT lights market.

Technology Update
In the operating room of the future, robots will be an integral part of the surgical team, working alongside human surgeons to make surgeries safer, faster, and more precise. Engineers in Michael Yip’s lab at UC San Diego are developing advanced robotic systems to help make that vision a reality.

From intelligent algorithms that can enable robots to lend a helping hand during surgery, to smart endoscopes that can autonomously maneuver through sensitive nooks and crannies inside the body, the robotics technologies in Yip’s lab are all inspired by a common goal – to augment the capabilities of surgeons.

The goal is not to replace human surgeons, but to better assist and enable them to do much more, said Yip, a professor of electrical engineering. Human surgeons, he explained, are still needed to make decisions that cannot be left to a robot, such as what treatment is best for the patient, or how a surgical procedure should be performed. Meanwhile, robots will be used to perform tasks that humans cannot. For example, flexible and dexterous robots armed with high-power computing and sub-millimeter precision will be able to perform minimally invasive surgery, control complex instruments, and navigate through spaces in the body that a human surgeon cannot access. These robots could perform other advanced tasks, such as creating real-time 3-D maps inside the body as they self-navigate, relying on a patient’s medical data and imaging information.

In an age of increasing automation, researchers in the institute, such as Yip, are focused on developing robotic systems that can interact well in a human world and benefit society.

Automated Surgical Assistant. The da Vinci Surgical System is a robotic surgical system designed to perform minimally invasive surgery. The system, developed by the company Intuitive Surgical, is remotely controlled by a surgeon from a console. The system is equipped with four robotic arms, but a surgeon is able to control only two of them at a time. Yip’s ARCLab currently has a full da Vinci Surgical System dedicated for research in shared autonomy. Yip’s team aims to put the other two arms to work. To do this, they are creating software and hardware that will enable these arms to function autonomously. A goal is to have these robotic arms assist the primary surgeon with routine surgical tasks (suction, irrigation or pulling tissue back) that are tedious and are currently performed by additional human surgeons. This would reduce the number of surgeons in the operating room, which would reduce the overall cost of the surgery. It would also free up surgeons who normally do these tasks to see other patients.

Steerable Catheters. To reach truly small scales, the ARCLab is developing its own robotic catheters. These catheters are meter-long, millimeter-diameter flexible robots that can access the deepest parts of the body from atraumatic locations such as the leg. With eight wires that are individually controlled by eight different motors, Yip’s lab can shape and steer the robot catheters in more complex configurations and navigate far more effectively than surgeons could do manually.

Artificial Muscles. For robots to move with more agility and speed, they will need human-like muscles. To that end, postdoctoral researcher Jun Zhang and bioengineering undergraduate Taylor West are making artificial muscle fibers that can quickly contract and relax while holding weight. The muscle fibers are made of silver-coated nylon threads that are spun into a tightly coiled structure. When voltage is applied to the fibers, they heat up and contract. As they cool, they relax back to their original length. By braiding multiple coiled fibers together, researchers can create a stronger muscle that can lift a heavier load. Researchers aim to use these artificial muscles to build life-like robotic arms, prosthetics, orthotics, and robotic augmentation devices for people with poor muscle function.

Way Forward
The future belongs to minimally invasive surgery and, therefore, also to intraoperative imaging as well as hybrid operating rooms. For cost reasons, it is no longer just the cardiovascular disciplines that utilize hybrid ORs. Other sub-disciplines like neurosurgery, traumatology, or orthopedics can also benefit from 3-D imaging and the higher image quality of an angiography system. The system needs to be seamlessly integrated into various operating procedures of different disciplines in the OR, ranging from orthopedic to vascular surgeons. It needs to have all necessary functions for various disciplines to operate optimally. The trend also is in the interdisciplinary utilization of the hybrid OR – all the different disciplines perform more and more complex procedures. Thus, high-end imaging equipment makes perfect sense. Probably, the future hybrid OR will provide optimal conditions, so that different disciplines will be able to use the room.

The technological development increasingly moves toward the area of image correlation. Data from various modalities such as ultrasound, X-ray, and MRI are merged and they complement one another, thereby reducing X-ray exposure and using minimum amounts of contrast media. The integration of OR systems with various devices will also play an increasing role in the future and present a challenge for manufacturers and users. At the moment, all manufacturers have their own operating philosophy the OR staff needs to understand. In the future, this should be different to where the different technologies communicate with each other and equipment can be used effectively. Even though these ideas have already been initiated, they will continue to accompany us over the next few years and perhaps even over the next decade.