Advanced Therapies

Hybrid OR Advanced imaging enabling improved outcomes in therapy!

September 20, 2017

“Os desafios de um Hospital Atual” – Madeira

Pedro Goldaracena

Business Development Manager Surgery - WEA region

Advanced Therapies

Benefits?

Definition?

Integration?

Influence of images in HOR?

Practical aspects?

Why hybrid?

ROI?

Advanced Therapies

The concept of Hybrid OR Blurring the lines between Surgery & Intervention

Less invasive

Interventional

Angiography

More invasive

Surgery Hybrid

Endovascular &

surgical procedures in

1 place

Advanced Therapies

Definition of Hybrid OR Room (HOR)

1 • Image guided therapeutic room

2 • « multifunctional », « multiuser » in the OR department

3 • Sterile environment with advanced 3D applications

4 • Allowing open surgery & percutaneous approach, including endovascular procedures

Team work

Surgeons / Radiologists / Cardiologists

Different

imaging methods

Advanced Therapies

Artis zeego

Advanced Therapies

Why going Hybrid?

Instead of open surgery most surgeries will be performed minimally invasively

3D imaging will be important to guide the procedure

…and will enable robotics to play a larger role in surgery

Invasive Minimally

invasive

Surgical procedures are getting

more minimally invasive Trends in surgery

Advanced Therapies

New therapeutic approaches that will change the dynamics!

TAVI EVAR RFA RD

UFE LAA PAE MVR

Advanced Therapies | AT-16-468.

Page 8 | © Siemens Healthcare GmbH, 2016

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Minimally invasive procedures are on a constant increase and demand advanced imaging

http://www.ncbi.nlm.nih.gov/pubmed/26384006 Veith Symposium 2013, New York, NY, USA; Grand View Research Report, published January 2016

~20× Increase of TAVI in 6 years from

637 to 13,264 in Germany

~4.5× Increase of EVAR procedures in

the US in 9 years from 11,028 to 50,220

+10.1% Compound annual growth rate

for embolization procedures

Firs

t lin

e

Transaortic Valve

Implantation

Endovascular

Aortic Repair

Transarterial

Chemoembolization

TAVI EVAR TACE

Advanced Therapies

Benefits of Hybrid procedures

• Improved patient outcomes with less invasive

procedures

• Broader applications with 3D imaging technology.

• Combine the best therapeutic options from surgery and

interventions

• Fewer per-procedural complications

• Shorter ICU stays in the hospital directly linked to

increased profits.

• High risk patients can now be treated with minimally

invasive treatment

Advanced Therapies

Clinical fields in minimally invasive surgery

Vascular Surgery

Cardiac Surgery

Thoracic Surgery

Neuro Surgery

Spine Surgery

Orthopedic/ Trauma Surgery

Laparoscopic Surgery Urology

Advanced Therapies

* WIP / Courtesy of Pr Jacques Marescaux / IHU Strasbourg - Ircad

Hybrid OR of the future with Augmented Reality*

Advanced Therapies

The complex environment of Hybrid OR What equipment ?

Advanced Therapies | AT-16-468.

Page 13 | © Siemens Healthcare GmbH, 2016

Imaging systems for Hybrid OR

Firs

t lin

e

Hybrid OR with

CT/MRI imaging

Conventional OR with mobile C-arms

Hybrid OR with fixed C-arm systems

NEW

MIYABI Angio-CT is a customized solution and not commercially available in all countries. Due to regulatory reasons the future availability cannot be guaranteed.

Advanced Therapies

2

1 3

4

5

6

1. Anesthesiologist

2. Surgeon

3. Interventionalist

4. Scrub Nurse / Physician

5. Circulating Nurse

6. Perfusionist

7. Device preparation

8. Echo technician

9. X-ray technician

10.Students

The complex environment of Hybrid OR Who is working where?

7

8

9

10

Advanced Therapies

The complex environment of Hybrid OR Who are all the stakeholders?

Medical team

Hospital CEO Architects

Biomedical Engineer

Civil works department

Purchase department

Hygiene Department

Design agency

Independent auditor

Building company

Need to appoint a “leader” at customer site

Advanced Therapies

The 6 points to consider in Hybrid OR project

Location & Space

• IC/IR vs. OR

• Aseptic level

• Square meters

1 Transesophageal echo

2 Transthoracic echo

3 Intracardiac echo

4 Intravascular ultrasound

5 Extracorporeal circulatory unit

Adjunctive Technology

• TEE1

• TTE2

• ICE3

• IVUS4

Imaging

system

• Floor, Ceiling,

Robotic

•Detector size

•Single vs. Biplane

•CT/MR

Surgical Table

•Surgical vs.

imaging table

Surgical Equipment

• Light placement

• Light model/type

• Anesthesia

• Endoscope

• Monitoring

• Booms

• ECU5

Audio-Video Integration

•Touch screens

•Large Display

• Video conferencing

•RIS/PACS

integration

Advanced Therapies

Integration is key Our global partners in surgery

OR tables

Navigationsystems, devices, endoscopes

Robotics

Other

Advanced Therapies

Most popular Angiography system configurations for Hybrid rooms

The single plane floor-mounted configuration accounts for

64% of SELECTplus member hospital interest, with Siemens as

the most popular vendor for this configuration, followed by

GE and Toshiba. Philips generates the majority of member

interest for both single plane ceiling and biplane configurations.

Interest among SELECTplus member

hospitals and health systems, based

on SELECTplus Market Analytics

Source: www.ecri.org/hybrid

©2013 ECRI Institute.

Provided by ECRI Institute’s SELECTplus Market Analytics

Advanced Therapies

How much does a Hybrid OR really cost?

Advanced Therapies

Pay Back Period for hybrid OR for small and midsize hospitals

2,5 years €

Source: “Financial Aspects – Hybrid Operating Rooms”, G. M. Cronin, 2010

http://webcast.aats.org/2010/presentations/27B.03-1.pdf

*Source: KU Gesundheitsmanagement 2/2012

Advanced Therapies

Let‘s build a Hybrid OR

Advanced Therapies

Room requirements

Separate technical, control, examination rooms

Ceiling 4,5m to 4,9m height (floor to floor)

Lead-lined walls for radiation protection

Increased ceiling support for equipment booms

Positive pressure and laminar airflow for OR-level sterility

Standard OR

~55 m2

Hybrid OR ~92 m2

Examination

room Control

room

Technical

room

Floor mounted Ceiling mounted Robotic

Ideal room

size for the

examination

room only

~55 m2 ~45 m2

~65 m2

Advanced Therapies

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Floor

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Weights and forces

Point loads

Static requirements

Substructures

Cabling (cable ducts, bore holes, conduits)

Floor covering

Radiation protection Flexible, movable

substructure

Floor

Advanced Therapies

Walls, Doors, Windows

Advanced Therapies

Wall systems, Doors

Medical gases

Cabling (wall ducts, conduits, etc.)

Radiation protected windows

Wall heating

Video management

OR-Tableau

Radiation protection

Walls, Doors, Windows

Advanced Therapies

Ceiling

Advanced Therapies

Weights and forces

Point loads

Static requirements

Substructures

Cabling (cable trays, conduits)

Heating and cooling

Medical gases

Radiation protection

Ceiling

Advanced Therapies

Angio Systems

Advanced Therapies

Angio Systems

ceiling mount

Floor mount robotic

ceiling mount floor mount

biplane

mobile

Advanced Therapies

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• To ensure a clean and swift workflow with bullet points, please use the PRE-SET PLACEHOLDERS or FORMATTED TEXTBOXES – do not use “normal” textboxes that have been added via the steps add textbox. These textboxes cannot be formatted with the automatic formatting step

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

• Placeholders can be filled and then copied. The copied placeholder will keep its formatting

LAF Ceiling

Advanced Therapies

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

• Placeholders can be filled and then copied. The copied placeholder will keep its formatting

LAF Ceiling

Advanced Therapies

For changing images, please delete them and insert a new one over click insert icon

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

• Placeholders can be filled and then copied. The copied placeholder will keep its formatting

Surgical Lights

Advanced Therapies

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OR lights , Cameras

Advanced Therapies

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Monitor Pendants

Advanced Therapies

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Monitor Pendants

Advanced Therapies

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

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Anaesthesia, surgical pendants etc.

Advanced Therapies

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

• Placeholders can be filled and then copied. The copied placeholder will keep its formatting

Anaesthesia, Surgical Pendants etc.

Gases: O2, N2O, Air, CO2

Vacuum, AGSS, Airmotor

Sockets 203 V

Video, Network (VGA, DVI, BNC, RJ45)

Monitor holder VESA (Hemodynamic, etc.)

Potential equalization

Advanced Therapies

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

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Theatre Lighting

Advanced Therapies

Additional Equipment

Advanced Therapies

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Additional Equipment - Injector

Advanced Therapies

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Additional Equipment – Navigation System

Advanced Therapies

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Additional Equipment – Microscope For Spine And Neuro Surgery

Advanced Therapies

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Additional Equipment – Heart Lung Machine

Advanced Therapies

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

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Additional Equipment – Surgery Robot

Advanced Therapies

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Additional Equipment – Video Management System

Control Room Technical Room

Operating Theatre

8 Out

TEGRIS Videomanage

ment

12 In

Out

Display Management

In

56“ 24“

24“

Vital Signals + ECG

Ultrasound

Endoscopy

Neuro Navigation

Room Camera

Surgical Light Camera

Nurse Working Station

Spare Input

LEFT

RIGHT

Artis Zeego Cockpit Cockpit Controller 6 Syngo xwp DVI 1280 x 1024

LEGS

WALL

42“ option

56“

42“ option

Maximum 8 inputs (all signals)

Excl. HD-SDI input signals

Advanced Therapies

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• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

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Additional Equipment – Instrument Tables

Advanced Therapies

Let´s build a Hybrid OR with Angio and CT

Advanced Therapies

Hybrid OR With Angio and CT on rails

Advanced Therapies

Let´s build a Hybrid OR with Angio, CT & MR

Advanced Therapies

For changing images, please delete them and insert a new one over click insert icon

• To ensure a clean and swift workflow with bullet points, please use the PRE-SET PLACEHOLDERS or FORMATTED TEXTBOXES – do not use “normal” textboxes that have been added via the steps add textbox. These textboxes cannot be formatted with the automatic formatting step

• AUTOMATIC INDENTATIONS IN PLACEHOLDERS are only to be done using the tool decrease or increase the list level (or Shift + Alt + / )

• Formatted textboxes/ placeholders are available in the template – just make a copy OR: generate a new placeholder by following these steps Start new slide choose layout "Content Slide"

• Placeholders can be filled and then copied. The copied placeholder will keep its formatting

Hybrid OR with Angio, CT on rails & intra operative MR

IHU Strasbourg - France

Advanced Therapies

September 20, 2017

“Os desafios de um Hospital Atual” – Madeira

Pedro Goldaracena

THANK YOU!