Inside Duke Medicine

Hybrid OR advances collaboration, patient care

DUH’s Hospital Addition for Surgery (HAFS) project goes back to 2006 but is entering an important third phase that will culminate in the spring of 2010 with the opening of Duke’s first hybrid operating room.

A hybrid OR is a typical state-of-the-art surgical suite with the added advantage of angiography imaging equipment mounted to the ceiling – equipment traditionally exclusive to cardiac catheterization and interventional radiology labs. It makes possible a transition from minimally invasive to open vascular or cardiothoracic procedures without having to move the patient.

HAFS’ third phase also will add four new cardiac ORs in addition to the hybrid OR – giving DUH a total of 35 ORs and addressing the need to treat a growing patient population with timely care and to offer improved technology for surgical teams.

The new ORs will be 670 square feet, larger than the current ORs on the floor, which average 450.

The hybrid OR also will mean Duke will be eligible to participate in clinical trials testing innovative technology that may revolutionize cardiac valve repair and replacement using percutaneous catheter-based technology.

Here is an article on the HAFS project, from the September 2009 edition of Inside Duke Medicine:

In HAFS renovations, DUH gets more room to operate

The new Duke Medicine Pavilion that will open in 2013 will add 16 new high-tech operating suites to Duke University Hospital.

But that’s not the only effort underway to increase the capacity of DUH to treat a growing patient population and provide state–of–the– art operating rooms.

The Hospital Addition for Surgery and related renovation activities have been underway since 2006. This $73.7-million construction and renovation project, which is modernizing and expanding the operating room platform in DUH, is about to enter its third phase—that will see the opening of Duke’s first hybrid OR, a very large surgical suite with built-in heart imaging technologies.

In the first phase of the project, an eight-story, 77,684–square-foot addition was tacked onto the south side of Duke North. It opened in June 2008, making room for the relocation of administrative offices and the creation of OR clinical infrastructure space to support OR operations. Phase one also included upgrades to the DUH roof and relocation of Life Flight’s helipad to the roof.

In phase two, the vacated areas in the hospital were renovated into an expanded family–friendly waiting room and a pre-operative and post-anesthesia care unit (PACU). These spaces, unveiled in April, cater to surgical patients and their families, offering not only comfort but also improved privacy and functionality.

Now, phase three will add four new cardiac operating rooms and a new hybrid operating room, bringing the total ORs at DUH to 35. The extra ORs address the pressing need to provide timely care and improved technology for our surgical teams. The majority of the current ORs are at 95 percent utilization.

Each of the four additional rooms will encompass up to 670 square feet—larger than the current ORs elsewhere on the floor, which average 450 square feet.

“Enlarging the size of the ORs will enable Duke to better accommodate new technology and staffing levels that are becoming the standard for procedures performed at the hospital,” said Kevin Sowers, MSN, RN, chief executive officer of DUH.

And in the middle of this row of new ORs, builders will also create an 870-square-foot hybrid OR, a first for DUH.

A hybrid OR is a surgical suite with angiography imaging equipment that is mounted to the ceiling or floor—traditionally exclusive to cardiac catheterization and interventional radiology laboratories. This OR will also have all the appropriate surgical lighting, surgical table, equipment booms for endovascular equipment, ceilingmounted flat-panel monitors, anesthesia equipment, perfusion console, designated sterile field, and other components found in typical OR suites.

“The hybrid OR is perceived as a ‘best of both worlds’ environment by surgeons and interventionalists alike,” said Danny O. Jacobs, M.D., MPH, David C. Sabiston Jr. Professor and Chair of the Department of Surgery. “In a hybrid OR, it is possible to transition from minimally invasive to open surgical procedures in emergent situations without transporting the patient from a procedural area like the cath lab to an OR.”

The specialized angiography system can be used before or after an open surgical procedure, to provide diagnostic imaging during a fully interventional procedure, or to support combined open and interventional procedures.

Surgical procedures most likely to benefit from fixed angiography in the hybrid OR include procedures historically performed as open surgical procedures but that are now being transitioned to catheter-based and minimally invasive alternatives, such as abdominal or thoracic aortic aneurysms, aortic and mitral valve replacements and numerous endovascular surgical procedures such as peripheral stenting.

Although the hybrid OR will primarily be used for vascular and cardiothoracic specialties, it also will be designed to accommodate the needs of any general surgery procedure in order to provide the greatest flexibility to meet patient needs, OR utilization and capacity, said Sowers.

“The hybrid operating room is essential for promoting Duke’s signature service for cardiothoracic and vascular specialties,” said Jacobs. “Duke Hospital must be capable of offering patients every viable treatment option, and with this hybrid OR, patients will have access to the latest trends in minimally-invasive and catheter-based treatment options.”

The new hybrid OR, scheduled for first use in April 2010, will also mean Duke will be eligible to participate in clinical trials testing innovative technology that may revolutionize cardiac valve repair and replacement using percutaneous catheter-based technology.