Penrose’s hybrid OR will help surgeons

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Cardiovascular surgeon Dr. John Mehall leads a team during coronary bypass surgery at Penrose Hospital.

Cardiovascular surgeon Dr. John Mehall leads a team during coronary bypass surgery at Penrose Hospital.

Using millions of dollars donated by El Pomar Foundation and the Colorado Springs community, Penrose Hospital has commenced building a hybrid operating room.

Set to be functional in the spring, the $5.7 million OR combines different elements of surgical procedures, said cardiovascular surgeon Dr. John Mehall.

The hybrid operating room will allow surgeons to complete their procedures using real-time radiologic information from ultrasound or X-ray machines during the surgeries.

Currently, patients visit the radiology department before surgeries and have X-rays and ultrasounds taken there. The surgeon studies the static X-rays and other radiologic information before performing the procedure.

For example, during a trans-aortic valve replacement (TAVR), physicians can replace a heart valve without opening the patient’s chest. This method allows a heart surgeon to replace the valve by deploying it into the heart using a wire through a vein in the leg, said Chris Valentine, hospital spokesman.

Typically, these procedures do not take place in a regular operating room.

“If for some reason they need to transition to a regular operating room [during the procedure, if something goes wrong], they can without traveling down the hall to an operating room,” using the hybrid operating room, Valentine said. “You’re saving precious time.”

The hybrid operating room includes radiologic machinery as well as monitors to communicate the surgical information throughout the room.

Rather than performing the procedures using “the naked eye,” the physicians, nurses, and others in the hybrid surgery suite can access live information on monitors above the patient and direct their actions based on that information.

“The concept is that you’re integrating procedural interventions done off imaging rather than from direct visualization,” Mehall said. “I’m doing something based on that image to guide me, as opposed to looking at the actual tissue itself.”

The hybrid operating room combines the appropriate technology in the same room the procedure will take place.

“There are a huge number of screens,” conveying information such as vital signs, ultrasounds, X-ray studies and more, Mehall explained.

“The ability to have access to all that information — everybody’s on the same page,” he said. “Before, the only person who could see what was going on was the surgeon.”

Others in the surgical suite can anticipate stages in the procedure and prep for them.

“The nurses will see something and get more supplies,” Mehall said as an example. “It’s really a form of communication.”

Big incisions, small incisions

“A lot of the time, when we make big incisions, it’s basically to see,” Mehall said.

“Obviously, if we’re removing a large tumor, you need a large incision,” Mehall said. “If you’re doing something small, the only reason to make a big incision is to see what we’re doing.

“If we can see using other means, then we don’t need to make a big incision,” he said.

“We’re currently doing all the same things, but we’re doing it in the Hyundai,” Mehall said of current operations. The hybrid operating room is “the Ferrari of rooms.”

Smaller incisions translate to less trauma and faster recovery.

The hybrid operating room is roughly twice the size of a regular operating room. At 2,000 square feet, it is “one of the largest hybrid operating rooms in the country,” said Lonnie Cramer, Penrose vice president of operations.

There, between 15 and 20 health care professionals can work on a single patient at a time.

“It looks large until you put all the equipment in the room. Then you say, ‘Where did all the space go?’ ” Mehall said.

Traditional operating tables will appear in X-rays, so they wouldn’t work in the hybrid operating room.

Operating table manufacturer Maquet has made a radiolucent table from carbon fiber, “so you can X-ray right through them,” Mehall said.

The hospital has other carbon fiber tables, but the table for Penrose’s new hybrid operating room enables the patient to be manipulated in different angles, Cramer said.

When the image-guided procedure is no longer appropriate, the equipment can be simply moved aside, and the room turns into a regular operating room, Cramer said.

Mehall said some 250 procedures can be performed in the hybrid operating room just in the cardiovascular department. Neurosurgeons will also be able to utilize the room.

“I would guess we would do more than 400 different procedures in this room, and that would free up other rooms,” Cramer said.

Patient benefits

For minimally invasive heart valve surgery, the average length of stay is half that of a standard open heart procedure, Mehall said, “and the recovery period is about half as long.”

“Our program is growing,” Cramer said. “This is a tremendous addition to our cardio-thoracic program.

“We’re the only hospital in the region doing trans-catheter heart valves, the only ones doing minimally invasive valve surgery, robotic cardiac and lung surgery.”