Hybrid Room _maquet

HYBRID OPERATING ROOM SOLUTIONS

HYBRID OPERATING ROOMS

CONTENT

The complex Hybrid OR - Challenges and Solutions The Hybrid Operating Room

Planning the Hybrid OR

In Synchrony with the Angio System: MAGNUS Hybrid OR Table Selecting Products for the Hybrid OR In Synchrony with the Angio System: MAGNUS Hybrid OR Table Optimal Illumination: HLED OR Lights Leading Edge OR Integration: TEGRIS Everything within Reach: MAQUET Ceiling Supply Units Selected References

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THE HYBRID OPERATING ROOM

3


HYBRID OPERATING ROOM

Is it

Why is it hybrid?

the combination of two technologies? the combination of an operating room and an imaging system? the possibility to use the operating room for different disciplines? the combination of an operating room and a cathlab?

4


HYBRID OPERATING ROOM LEVELS

Converted cathlab or converted operating room

From the simplest to the most advanced:

g Previously, most Hybrid ORs were simply cathlab rooms made

sterile or normal ORs with a more advanced C-arm system

True Hybrid Operating Roomy p g A true Hybrid Operating Room is the merger of a fully equipped

operating room and a fully equipped cathlab

Multi-disciplinary Hybrid Operating RoomMulti disciplinary Hybrid Operating Room The Hybrid OR can be used for different disciplines e.g. cardiac,

vascular, neurological and orthopaedic interventions thanks to interchangeable OR table tops and flexible equipment

5


THE HYBRID OPERATING ROOM

Fusion of a cathlab with an operating room:

+ =

Cathlab Operating room Hybrid operating roomCathlab Operating room Hybrid operating room

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CATHLAB VERSUS OPERATING ROOM

General General

Cathlab: Operating room:

Used for percutaneous proceduresLocal anaesthesiaEnvironment

Used for surgical proceduresGeneral anaesthesiaEnvironment

X-ray environmentEquipment

Angiography system

Sterile environmentEquipment

OR table, OR lights, CSU:sC-Arm, cathlab tableHD monitorsControl room/Data Processing

Anesthesia systemHeart-lung machine, IABPEndoscopy equipment

Advanced patient monitoringPersonnel

Cardiologist, interventional radiologist

Ultrasound equipmentPersonnel

Surgeon(s), surgeon assistant

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ElectrophysiologistCathlab technicianCathlab nurse

Anesthesiologist, anethetistPerfusionistOR nurse


PROCEDURES IN THE HYBRID OPERATING ROOM

OR(Surgical procedures)

CATHLAB(Percutaneous procedures)

HYBRID ROOM(Hybrid procedures)

Heart Valves Surgical valve repair/ Transcatheter mitral valves Transapical aortic valvesHeart Valves replacements Transcatheter mitral valves Aortic valves/PCI

Coronary Disease CABG (Coronary Artery Bypass

Grafting) using Vein grafts, radial grafts, internal

mammary grafts

PCI (Percutaneous Coronary Intervention) using

BMS (Bare Metal Stents)DES (Dr g El ting Stents)

CABG/PCI TECAB (Robot) + PCI Completion angio after CABGmammary grafts DES (Drug Eluting Stents) C p g C G

Aortic Procedures AAA (Aortic Aneurysm Repair) TAA (Thoracic Aneurysm Repair)

EVAR (Endovascular Aneurysm Repair)

TEVAR (Thoracic Endovascular Aneurysm Repair)

Hybrid aortic arch procedures

Other Procedures Pacemaker implants LVAD (Left Ventricular Assist Devices)

Implants Structural and congenital heart

procedures

8


PROCEDURE EXAMPLE

T diti l th d

Aortic valve replacement:

Traditional method: Open-heart surgery Use of heart-lung machine High stress level for the patient

In the Hybrid Operating Room: Percutaneous aortic valve replacement Performed on a beating heartg Heart-lung machine in stand-by position Better outcome for high-risk patients

9


BENEFITS OF A HYBRID OR

Less complications and less surgery revisionsp g y Highly accurate surgery with real time control Patients real anatomy can be considered during

the surgeryg y

Patient can be treated with greater care Allows all types of surgeries (Neuro, Ortho,

Cardio/Vasc)Cardio/Vasc)

Time for patients treatment is reduced, as there is only one combined procedure instead of twoof two

Interdisciplinary use of the Hybrid OR supports cost effectiveness

10


TEAM EXAMPLE CARDIAC HYBRID PROCEDURE

Not uncommonly, 12-20 persons can be involved in a Hybrid OR procedurey y


THE COMPLEX HYBRID OR CHALLENGES AND SOLUTIONS

12


TYPICAL CHALLENGES

Getting Return on Investmentg Managing technical complexity Creating an attractive workplace Being prepared for future needs Finding the right partner

13


GETTING RETURN ON INVESTMENT

Building a Hybrid OR is a huge

Typical challenge:

g y ginvestment

Many stakeholders need to be convinced of the benefits Cost per Patient

The key is making sure that the Hybrid

Our recommendation:

p=

Total Cost per DayNumber of Procedures per Day The key is making sure that the Hybrid

OR has a high usage rate

Make sure that both surgeons and inter entionists feel at home in the

Number of Procedures per Day

interventionists feel at home in the Hybrid OR

Make sure that the room is designed for ltidi i li d di

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multidisciplinary use depending on expected case mix


MANAGING TECHNICAL COMPLEXITY

A Hybrid OR is a highly complex technical

Typical challenge:

y g yenvironment

Having to redesign a Hybrid OR can be very costlyy y

Make sure all stakeholders are involved

Our recommendation:

Make sure all stakeholders are involved during the planning phase

Use simulation and visualization tools for ario s orkflo scenariosvarious workflow scenarios

Select a partner with thorough workflow experience

15


CREATING AN ATTRACTIVE WORKPLACE

In a highly complex technical

Typical challenge:

g yenvironment, a large team needs to work efficiently and safely

Ergonomy must be the top focus

Our recommendation:

Ergonomy must be the top focus The layout needs to be well aligned with

anticipated workflows

Ergonomically designed equipment should be selected

Colours, lights and decorative elements

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Colours, lights and decorative elements help create an appealing working environment


ENSURING A FUTURE-PROOF SOLUTION

In 5-10 years, the Hybrid OR will probably

Typical challenge:

y y yneed to accomodate new technical equipment and solutions

Every year upgrades are likely to happeny y pg y pp

Plan with additional floor space

Our recommendation:

Plan with additional floor space Use flexible wall and ceiling elements Make sure that wall elements, ceiling , g

pendants, etc can accomodate additional cabelling, etc

17


FIND A SUITABLE PARTNER

Apart from the imaging system, the

Typical challenge:

g g yHybrid OR incorporates a large amount of equipment, often involving different suppliers and contractors

Time and project control is criticalOur recommendation:

Select one partner With documented experience of handling

complex projectsp p j

Who sources the critical equipment in-house With good references of similar projects

18


MAQUET SELECTED REFERENCE PROJECTS

Country Hospital Angiography OR table InstallationCountry Hospital Angiography OR table InstallationDenmark, Odense University Hospital Odense Philips Allura Xper MAGNUS 2010

Switzerland, Aarau Kantonsspital Aarau Philips Allura Xper MAGNUS 2010

Germany, Wrzburg University Hospital Wrzburg Philips Allura Xper MAGNUS 2010

Thailand, Siriraj Siriraj Hospital Philips Allura Xper MAGNUS 2010

USA Virginia Fairfax Inova Hospital Philips Allura Xper MAGNUS 2010USA, Virginia, Fairfax Inova Hospital Philips Allura Xper MAGNUS 2010

USA, Montana, CapeGiradeau St. Francis Hospital Philips Allura Xper MAGNUS 2010

USA, Lousiana, La Fayette Lady of Lourdes Hospital Philips Allura Xper MAGNUS 2010

USA, North Carolina, Durham Duke University Hospital Philips Allura Xper MAGNUS 2010

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MAQUET SELECTED REFERENCE PROJECTS

Country Hospital Angiography OR table InstallationCountry Hospital Angiography OR table InstallationJapan, Sendai Sendai Welfare Hospital Toshiba Infinix ALPHAMAQUET 1150 2009

Japan, Tokyo Mitsui Memorial Hospital Toshiba Infinix ALPHAMAQUET 1150 2009

Germany, Karlsruhe Cardiac Centre Karlsruhe Philips Allura Xper ALPHAMAQUET 1150 2009

France, Massy Institute Hospitalier Jacques Cartier Philips Allura Xper ALPHAMAQUET 1150 2008

Nationwide Childrens HospitalUSA, Ohio, Columbus

p

(formerly Columbus Childrens)Toshiba Infinix ALPHAMAQUET 1150 2007

Germany, Cologne Cardiac Centre Cologne Philips Allura Xper ALPHAMAQUET 1150.16 2007

Italy Genoa Gaslini Hospital Genua Philips Allura Xper ALPHAMAQUET 1150 16 2003Italy, Genoa Gaslini Hospital Genua Philips Allura Xper ALPHAMAQUET 1150.16 2003

Switzerland, Basel University Hospital Basel Philips Allura Xper Duplex Column - AWIGS 2002

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PLANNING THE HYBRID OR

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EQUIPMENT IN THE HYBRID OR

Angio System Patient monitoring system

Typical equipment to be considered:

OR Table OR Lights

Laminar air flow system Echocardiograph

Ceiling Supply Units HR video cameras Digital OR Integration

Electrocautery Defibrillator Endoscopy tower Digital OR Integration

Anesthesia machine Heart-lung machine

Endoscopy tower Cell saver Contrast injector

Intra-Aortic Balloon Pump Radiation screen

22


EQUIPMENT IN THE HYBRID OPERATING ROOM

Various types of angiography equipment:

Ceiling-mounted Floor-mounted

23Bi-Plane System Mobile System


ROOM PLANNING

Minimum 60 m with a ceiling mountedRecommended size of a Hybrid OR:

gangiographic system

Minimum 80 m with a floor mountedangiographic systemg g p y

Plus

8-10 m preparation room 8-10 m control room 4-5 m technical room 10-15 m storage room

All-in-all, space required for the Hybrid OR

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can range between 80 and 120 m


ROOM PLANNING

Layout Media-utilities

Special considerations

Workflow analysis Collision points Action radius

HVAC system Room light Electrical outlets/controls

Definition of interfaces Detailed solutions

Structure

Utilities (gases, suction, etc) Laminar air flow

Regulatory compliance Structure Floor preparation Ceiling reinforcement needs

Regulatory compliance Hygiene/tightness Radiation

Wall system Ceiling system Door systems

Fire Safety Noise

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Glass elements


SOLUTIONS FOR DIFFERENT SPACIAL CONDITIONS

Hybrid OR with 54 m / 581 sq ft:

.

7

f

t

6

m

/

1

9

.

9 m / 29.5 ft

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ROOM PLANNING

10.2 m / 33 ft

Hybrid OR with 83.6 m / 899.8 sq ft:

Nurse Area

/

2

6

f

t

4 m / 13 ft

Hybrid OR

8

.

2

m

Control Room

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PLANNING IN OR3D

3D simulation software for visualisation of What you plan is what you get:

the complex Hybrid operating room at the earliest stage

Best tool for workflow consulting: gPositioning of all medical devices to give the ideal workflow and to best suit the staff's working practices

Giving customers a precise idea of the envisioned equipment: What you see is what you get

Checking that the final proposed solution meets expectations

28


PLANNING IN OR3D

CAD interface to import/export architect files Advantages:

Exact room layout(with all corners and dimensions)

Possibilit to get the q otation immediatel Possibility to get the quotation immediately after the end of the presentation/ configuration/simulation

OR3D Pl A t d l li ti t b OR3D-Player: A stand alone application to be given out to the customer (e.g. for customers internal meetings)

Integrated product knowledge to prevent mistakes during product configuration

A tool used from the sales reps up to the

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plant (what is designed by the sales rep is exactly the same information that goes to the factory line)


SELECTING PRODUCTS FOR THE HYBRID OR

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SELECTING PRODUCTS

Adapted products for Hybrid operating rooms

Benefits of MAQUET products:

y g

Flexible OR equipment Future proof room elements Future proof equipment Ergonomic workplace

A li k l Appealing workplace

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SELECTING PRODUCTS

OR Tables with X-ray capabilities and (full) integration into

Benefits of MAQUET products:

y ( ) gangiographic systems

OR Lights with wide swing range to be compatible with the angiographic systemg g p y

Ceiling Supply Units that can be used and positioned very flexibly in the Hybrid Operating Room

Di it l OR I t ti l ti f th t f i Digital OR Integration solutions for the management of images, videos and data

Room Design Elements: flexible walls and installation elements MAQUET also offers anaesthesia machines, heart-lung machines,

intra-aortic balloon pumps, patient transport solutions, etc

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IN SYNCHRONY WITH THE ANGIO SYSTEM

MAGNUS HYBRID OR TABLE

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MAGNUS OR TABLE SYSTEM

MAGNUS is the ideal choice for interventions In synchrony with the angio system

requiring unrestricted radiotranslucency

Full integration of MAGNUS with the angiography system*g g p y y

Simple operation and high safety thanks to synchronized movements*

3D X i i 3D X-ray imaging Automatic position control Bolus chase procedures

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*Currently only with the Philips Allura Xper FD 10/20 system


MAGNUS OR TABLE SYSTEM

Interdisciplinary use with different table

A variety of table tops available

p ytops: Radiotranslucent table tops for

percutaneous procedures

Modular table tops for open surgery

Tailor-made solutions: Six table top versions are available Three lengths: 2500, 2700, 3000 mm Two ranges of longitudinal shift:Two ranges of longitudinal shift:

600, 1000 mm

35


BENEFITS OF MAGNUS IN THE HYBRID OR

Improved tracking of contrast medium

Cardio/Vascular surgery and Radiology:

gthanks to a longitudinal shift up to 150 mm/s with MAGNUS

Motor driven X/Y shift , panning, allows for , p g ,comfortable use in radiological applications

Synchronous movement of angiography and MAGNUS for better radiological resultsMAGNUS for better radiological results while keeping the isocentre

Organ shifting through gravity while keeping the isocentrethe isocentre.

36



Radiolucent MAGNUS interface for head

Neurosurgery:

positioning accessories: 360radiotranslucent skull clamp for intraoperative monitoring

Synchronous movement of angiography and MAGNUS for better radiological results by keeping the isocentre

37



MAGNUS table top with 360

Spine / Traumatology:

radiotranslucency up to 1850 mm allows time saving, intraoperative imaging in 3D

Improved view for pelvic interventionsp p(inlet-outlet view)

Better imaging support for spinal surgeryR di t l t MAGNUS i t f f Radiotranslucent MAGNUS interface for head positioning accessories supports low artefact cervical spine treatment

38



Best Hybrid OR solution withintegrated OR table:

MAQUET can offer the most technically advanced Hybrid OR solution with a full synchronization between table and angio system.

MAQUET offers a universal table that can be used for hybrid procedures as well as for pure surgical procedures or pure interventional procedures.

MAQUET can offer a more compact (or less crowded) Hybrid OR solution as there is no need to have two tables in the room as with Steris of Skytron.

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OPTIMAL ILLUMINATION

HLED OR LIGHTS

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HLED OPERATING ROOM LIGHTS

Best illumination for every surgical Optimal illumination quality:

y gsituation, whether open or minimally invasive surgery

Point and shoot lightg Homogeneous deep 3D volume of light :

no need to refocus

A t ti Ill i ti M t (AIM) Automatic Illumination Management (AIM) Constant illumination in cavity Virtually no shadows Less heat at surgeon neck

41


HLED OPERATING ROOM LIGHTS

Truthful tissue restitution: presence of O2

Light without disturbance:

2 according to blood color

The best LED light for laminar flow, thanks to its opened design, its smooth surface and p g ,its low heat dissipation

LED inside: Patented and dedicated ambient light causing no reflection onambient light causing no reflection on monitors

42


POWERLED OPERATING ROOM LIGHTS

Flexibility and comfort of use

Ergonomics today and in the future:

y

Low ceiling compatibility Adapted lengths of extension arms,

Devices are easily positioned nearDevices are easily positioned near surgical team

Easy to position and move suspensions Upgradable platform: Enables equipment holders to be added

or changed after installation

43



Light heads above the patient tablePositioning of lights:

g Main light PWD 700 fixed SATELITE 1 PWD 500 as an additional one

to lit in corner

SATELITE 2 PWD 300: required if vein harvesting procedure

HD camera in light or on a separate arm for bypassing the surgeons heads

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Lights are positioned for conventional cardiac surgery

Special solutions:

g p g yapplication and femoral stage

If a laminar air flow is present in combination with a ceiling mounted system, surgical lights need very g y , g g ylong arms

Compact light head enables the efficient use of space which is critical in Hybrid Operating Roomswhich is critical in Hybrid Operating Rooms

Ceiling mounted extra shield could be installed to reduce the risk of exposure to radiation

45


LEADING EDGE OR INTEGRATION

TEGRIS

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TEGRIS - DIGITAL OR INTEGRATION

Improvement of the OR efficiency is key to Managing information complexity:

p y ymake best use of the significant investments associated with the design of an Hybrid Operating Room.

By centralizing video management, documentation, device control and room control on a single intuitive user interface, the complexity of the Hybrid Operating Room iscomplexity of the Hybrid Operating Room is significantly reduced

TEGRIS closes the gap between angiography and surgeryand surgery

TEGRIS improves the therapy workflow in the Hybrid Operating Room.

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Availability of patient related information Increases therapy efficiency:

y ppresented in the room is essential -supporting fast, safe and appropriate therapy decisions.

The number of screens and user interfaces can be reduced

TEGRIS positions the healthcare professional in the drivers seat of the high-tech Hybrid Operating Room.

48



Video routing for flexible use of monitors Information routed to where it is needed:

gbroadens the usability of the OR and supports an ergonomic working, while reducing the number of monitors required.

Presets for video routing configurations to set up the room according to the procedure help to accelerate patient change-over time.

49



Video capture enables documentation of all Sharing information, capturing and streaming:

pnon-angiography sources incl. endoscopy or OR light-cameras.

Video streaming to seminar-rooms or lecture ghalls provides the audience with a live-experience of state-of-the-art hybrid procedures.

50



1Quick and convenient setup of the monitor

The cockpit for integrated Hybrid Operating Rooms:

Routing1p

configuration presenting the information required for a specific procedure.

Capture2Easy documentation of non-angiography sources during the procedure via video capture Capture2 gof camera, endoscopes or other sources.

Streaming3Streaming and transmission of video and audio over the network e.g. to lecture halls or seminar rooms.

+

OR Control4Integrated control of OR-lights and room equipment incl. room lights and blinds.

+IT Integration

Seamless integration with hospital IT systems using international standards incl. e.g. HIS, PACS, DICOM.

51User Interface

A best-in-class user interface enables intuitive usage with minimal training time for the staff.


EVERYTHING WITHIN REACH

MAQUET CEILING SUPPLY UNITS

52


GENERAL LAYOUT

SurgicalPendant

Anesthesia Pendant:

Usually positioned at patients head area, Heart LungMachineSupport

ybut because it obstructs the movement of the angiographic C-arm, it has to be located at left side or right side.

Surgical Pendant:

Usually positioned at patients foot area, Anesthesia Pendant

where it can cover both sides of the OR table.

Perfusionist Pendant:Perfusionist Pendant:

E.g. heart lung machine support, which is usually positioned at patient right hand id

5353

side.



Optimal space management in the Hybrid Creating an efficient workplace:

g yOperating Room: Smart workflow solutions from MAQUET Compact designed CSUsp g Flexible positioning of the equipment

B t ki diti th k t Best working conditions thanks to: Ergonomic designed equipment Easy handling

5454



Monitors (imaging screens)For every type of equipment:

( g g )

Additional surgical lights HD camera Lead shielding Contrast injector Anesthesia system Anesthesia system Endoscopy equipment Other surgical equipment

55


GENERAL HYBRID OR CONSIDERATIONS

There are many screens in the Hybrid OR. Specific requirements:

y yThe pendant location should be optimized to avoid collisions, while considering access needs for required workflow.

Double arms are necessary in the Hybrid OR for large coverage.

Pneumatic brake is suggested in Hybrid ORPneumatic brake is suggested in Hybrid OR as it facilitates the movement.

If on-site integration is required MAQUET offers reserved cable management solutionoffers reserved cable management solution.

565656


THE ANESTHESIA PENDANT

The optimal space management is important for an efficient Cable management and minimal foot-print:

p p g pworkflow in the crowded Hybrid OR

Safety, hygiene and ergonomics is key High availability during surgical procedures out of the way High availability during surgical procedures, out of the way

during interventional procedures

No cables and gas hoses on the floor: The PLG system provides the anesthesia with all utilities required

PLG

provides the anesthesia with all utilities required

Minimized foot print: M-LIFTING lifts the anesthesia machine from the floor

5757

M-LIFTING


THE SURGICAL PENDANT

A Hybrid OR typically requires 6-12 monitors or moreSolutions for various types of surgical equipment:

y yp y q

The CSU can de designed as a media centre A large beam inner diameter is highly recommended The MODUTEC pendant can accommodate more

cables/hoses than most pendants on the market

5858


ADDITIONAL SUPPORT PENDANT

A third support pendant, beside anesthesia support and Available when you need them:

pp p ppsurgical support is necessary e.g. for the heart-lung machine.

As the third pendant is not used all the time therefore a parking position helps to save space and have a smooth p g p p pworkflow.

M-CARRIER places the surgical equipment at the optimal ergonomic height for the users across a range of up to

PLG

700mm height adjustment

M-CARRIER

5959

M CARRIER


CREATING AN ATTRACTIVE WORKPLACE

VARIOP ROOM DESIGN ELEMENTS

60


VARIOP ROOM ELEMENTS

Clinics face the question where to realize a

Adaptable to current and future needs:

qHybrid OR in their existing facilities. VARIOP is the optimum solution for conversion

and modernization measures. The modular t b d t d t ll t tisystem may be adapted to all construction

circumstances.

The prefabricated components guarantee short disassembly times and optimized flows.y p

Given the high volume of technical equipment, there is a considerable installation density in the Hybrid OR. VARIOP allows for y yeasy and swift access to the installation areas set in the walls and the ceiling areas.

61



Ceiling-mounted angiography units can be Versatility meeting the highest hygienic standards:

g g g yintegrated into the VARIOP metal cassette ceiling.

Floor mounted angiography units can be g g p yintegrated easily

The interventions performed in the Hybrid OR require compliance with the highest hygienerequire compliance with the highest hygiene standards. The high-quality powder-coated stainless steel surface fulfills these particular hygiene requirements excellently.

62



Thanks to the modular structure the OR Adaptable to growing needs:

grows with the technology The cabling, transmission and visualization

technology will change quickly and regularly -VARIOP permits the adaptation of the OR to theVARIOP permits the adaptation of the OR to the state of the art and minimizes downtimes resulting from non-availability of the rooms.

Should there be a change in surface requirements, these may be realized with the flexible wall system.

Radiation protection can be integrated into the Hybrid OR wall easily. New radiation protectionHybrid OR wall easily. New radiation protection requirements can be conducted at any time.

63



During the examination phase the patient is Creating a pleasant atmosphere:

goften still conscious, and thus the ambience plays an important role. The corresponding colors and images create a

friendly ambience, contributing to a greater sense of well-being for patients and personnel.

Colorful and dynamic light creates a friendly ambience and reduces stress situations both forambience and reduces stress situations both for patient and the OR team

64


SELECTED REFERENCES

65


REFERENCE PROJECTS

USA:

Nationswide Children`s Hospital Columbus/USAColumbus/USA

66


REFERENCE PROJECTS

France:

Institut Hospitalier Jaques Cartier/Massy/France

67


REFERENCE PROJECTS

Germany:

Cardiac CentreCologne/Germany

68


REFERENCE PROJECTS

Thailand:

Siriraj BKKBangkok/ThailandBangkok/Thailand

69


70


THANK YOU!

71


BACK UP

72


HYBRID OR PLAYERS

GE Toshiba Siemens Philips MAQUET Trumpf Steris Skytron Drger Stryker Storz

Angio-System, Floor-mounted x x x x

Angio System Ceiling mounted x x xAngio-System, Ceiling-mounted x x x

Angio-System, Mobile x x x x

Angio Table ? x x x

Hybrid Table x xy

Surgical Table x x x x

OR Lights x x x x x x

Ceiling Supply Units x x x x x x

OR Integration Systems x x x x x

Wall Elements x

Intra-Aortic Balloon Pumps x

Heart-Lung Machines x

Anesthesia Systems x x x

Patient Monitoring x x x

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PACS PACS PACS PACS Sterilisers Sterilisers Endoscopy Endoscopy

Ultrasound Ultrasound Ultrasound Ultrasound Disinfection Disinfection

Other products of interest for the Hybrid OR

Documents

Hybrid Room _maquet