Two surgeries in one

Vanderbilt takes lead in use of hybrid operating rooms

In 2005, Vanderbilt University Medical Center opened the Southeast's first hybrid operating room as a cardiovascular procedural suite. Its impact was quick and significant. 

In fact, during the nine years following the opening of the first Vanderbilt facility, hybrid ORs have become an increasingly common feature in modern hospitals.

VUMC now has seven hybrid ORs: four cardiac and catheterization labs, two neurovascular suites and one vascular suite.

The hybrid operating room, a surgical suite in which multiple procedures and medical imaging can be performed, allows surgeons and specialists to perform both major surgery and minimally invasive procedures with greater efficiency.

"It allows you to combine two different modalities to come up with one operation," says Dr. Michael Petracek, chair of VUMC's department of cardiac surgery.

Prior to the popularization of hybrid ORs, surgeries and minimally invasive procedures were performed separately, often in different floors or wings of a hospital. Naturally, this was a less-than- optimal system, as many patients needed both kinds of procedures. Additionally, imaging services — such as CT or MRI scans and X-rays —were performed elsewhere, further delaying procedures that needed imaging confirmation.

Alternatively, in cardiovascular suites like Vanderbilt's, patients can receive open-heart surgery. However, the room is also fully equipped as a catheterization lab, in which less invasive, catheter-based procedures are performed. In the hybrid OR, surgeons and interventional cardiologists work together and can combine stents with coronary bypass grafts, or transcatheter valves and arterial fibrillation surgery.

A common scenario involves the patient who needs both an open surgery as well as a minimally invasive procedure. But the reverse is also true —the decision can be made mid-procedure to switch to an open surgery approach without having to transport the patient or use suboptimal equipment.

"If you confirm a problem, you can always take a look at it through the X-ray,” Petracek says. “You accomplish as much or more than you would separately, with less risks or complication than before."

In the stroke suite, surgeons treat head and neck blood circulation problems such as strokes or aneurysm. Featuring high-tech imaging machines, doctors can conduct a neuroangiography — an X-ray that visualizes blood flow in the patient's brain — in real time, which allows surgeons to perform procedures with better accuracy in less time.

For example, a patient with a ruptured aneurysm is typically critically ill, says Dr. Michael Froehler, assistant professor of neurology and neurosurgery at Vanderbilt. That patient is near death and surgeons need to keep the aneurysm from erupting again.

"Through imaging, we can get a detailed picture of the aneurysm — its location and shape. And then we can decide what the best treatment for this patient is immediately," Froehler says. "That kind of patient would have had to go somewhere else, get their angiogram, then go back to the ICU while the doctors decide what to do, and then be brought into the operating room. That's easily a delay of several hours, whereas this is virtually instantaneous. We can go from the imaging and turn into an operating room to do a craniotomy."

Hybrid ORs allow surgeons to complete operations using less complex procedures by providing access to many resources and multiple teams of specialists — radiologists, anesthesiologists, surgeons, interventionists —and they also improve surgical outcomes, particularly when time and efficiency are most crucial. 

"We see ourselves as being stroke-ready 24 hours a day, seven days a week, 365 days a year," Froehler says. "We want to have one of our two suites ready at any time to treat a stroke patient, because time is so important."