Hybrid operating rooms redefine vascular patient care at the NAVC

EDMONTON – In September 2018, the Northern Alberta Vascular Centre (NAVC) at the Grey Nuns Community Hospital opened two, state-of-the-art vascular hybrid operating rooms (ORs). These advanced suites will improve care for vascular patients and benefit their care teams with added clinical efficiency, safety and effectiveness.

The two-year project integrated the latest technology from Canon Medical Systems Canada – the Infinix-i Sky Plus.

The Infinix-i Sky Plus contains a variety of features that compliment a multifaceted OR environment. The Canon-made innovation includes a double sliding C-arm that has flip, lateral flexibility, speed and full-body 3D imaging capability. It also has industry leading dose management tools designed to minimize patient X-ray exposure while maintaining image quality.

The advantage of hybrid ORs is their use of a large fixed imaging system that supports high-quality interventional images. This specific system of imaging contributes to the success of processes like fluoroscopy and the surgical procedures requiring it. The need for patient radiation exposure or imaging dye is greatly reduced.

“The substantial improvement in image quality allows us to deliver intravascular devices with a very high degree of accuracy,” said Dr. Gerrit Winkelaar, Head of Vascular Surgery at the NAVC.

“We can achieve this with significantly less radiation which makes the theatre safer for the patients, surgeons, anesthetists and OR staff.”

In addition, hybrid ORs support complex open and minimally invasive surgeries, exemplified by procedures such as Endovascular Aneurysm Repair (EVAR).

EVAR involves inserting a graft within the aneurysm through small groin artery incisions using X-rays to guide the graft into place. The new technology provides surgeons with exceptional image resolution in real-time, which means EVAR can be completed with more accuracy, speed and confidence than before.

The positive benefits of EVAR for patients include no abdominal surgery and decreased hospital stay due to a far shorter recovery period. Where traditional surgery would take three to six months to heal, EVAR results in a time of two weeks to several months for recovery.

Shorter surgery time and recovery time extends to other vascular treatments as well, including surgical bypasses, artery angioplasty and stenting.

Alberta Health Services supported the project with collaborative project management and a $10 million infrastructure and equipment budget. The creation of the NAVC’s hybrid ORs used several innovative design approaches during the project planning phase.

First, a multidisciplinary team took the idea from conception to tabletop, having a tangible diorama where everyone involved could gauge the flow of the rooms. Teams focused on the positioning of intraoperative equipment and how staff and patient would maneuver within the space.

A mock OR was then built to see all aspects of a room at an actual scale size with wooden replicas of the key pieces of equipment, such as OR bed, C-arm, monitors and anesthesia cart.

Program Manager of Operative and Endoscopic Services, Steve Lucas, says, “As the hybrid suites were constructed in existing OR infrastructure, it was imperative we maximized the functionality of the space we had.”

Vascular teams also practiced in the mock OR and used cameras to film various scenarios, including emergencies. From this analysis, human factors recommendations were integrated into the design.

Dr. Winkelaar said, “Everyone, from the surgeons and anesthetists, to the OR nursing staff and managers was given the opportunity to provide feedback on the design in a proactive manner, bringing their unique perspectives to the table.”

Lastly, virtual reality (VR) and Hololens technology was used to visualize the components of the operating room.

VR showed the multidisciplinary team an entire virtual room where they could see what colors the walls could be or how the C-arm moved within the space.

Similarly, the Hololens technology used a headset to show virtual objects integrated into the real world. Essentially, the team viewed where certain virtual objects could be placed in the mock OR without wasting time or energy on moving around physical items.

“The 1:1 scale mock up and the use of VR and Hololens technology was absolutely key to determining the best set up of the hardware and allowed for multiple changes to be made to the final design before building the suites,” adds Dr. Winkelaar.

The overall result led to less OR disruption in the hospital, and the efficiency of the build was able to meet construction timelines and budgetary expectations.

“Our future plans really centre around maximizing the technology to its fullest, routinely incorporating the fusion imaging technology to further reduce radiation and contrast administration,” says Dr. Winkelaar.

“There are also future opportunities to partner with cardiac surgery to provide endovascular treatments of ascending aortic aneurysm disease and other potential cardiac conditions.”

Hybrid ORs are one example of how Covenant Health is envisioning and actualizing better patient care for those they serve now and into the future.