The space needed and costs involved to create a hybrid operating room (OR) for a specific speciality may not be feasible, especially at mid-sized hospitals. This was the case at Middlesex Hospital in Middletown, Conn., where the facility wanted to increase procedural volume, but needed to upgrade its operating rooms. Joe Coatti, M.D., FACS, senior vascular surgeon, said the hospital had to contend with small rooms and low ceilings while balancing the needs of several specialties that planned to use a hybrid room for vascular, endovascular, laparoscopic and endoscopic procedures. In addition, he said procedures could be fatiguing due to the use of a fixed table requiring a lot of maneuvering of the C-arm. The location of fixed position monitors also caused difficulty in seeing small details over a distance.
Coatti said surgical cut-downs are sometimes needed for endovascular work, due to the 19-21 French-sized devices involved. So an operating room was needed instead of a cath lab. He previously used an older OEC 9800 C-arm system to perform endovascular abdominal aortic aneurysm repairs, but when he began performing occlusive vascular procedures, he needed a better angiographic imaging system. The hospital evaluated other systems, but decided on a GE OEC 9900 mobile C-arm, which can be moved out of the way to make room for laparoscopic and endoscopic procedures.
“To dump a million bucks into a system for me just to do vascular work was not very palatable. But, with this system, different specialties can perform other procedures,” Coatti said.
The hospital had to upgrade its ORs using existing space, and at the time had small, 400-square-foot ORs. Coatti said a nurses’ lounge was moved to enable a build-out of three 600-square-foot ORs. The hybrid OR uses a floating Steris table, which allows greater freedom in patient positioning, rather that repositioning the C-arm. To contend with the lower ceiling height, the hospital installed a Nu Boom ceiling-mount system to suspend numerous monitors and other equipment. The booms allow equipment not in use to be swung out of the way to create more space. It also allows monitors to be positioned anywhere around the patient table.
“I can bring the monitor right in front of me for really good visualization of the procedures,” Coatti said.
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