Hybrid operating room

A hybrid operating room is an advanced surgical theatre that is equipped with advanced medical imaging devices such as fixed C-arms, X-ray tomography (CT) scanners, or magnetic resonance imaging (MRI) scanners. These imaging devices enable minimally-invasive surgery. Minimally-invasive surgery is intended to be less traumatic for the patient and minimize incisions on the patient and perform surgery procedure through one or several small cuts.^{[citation needed]}

Though imaging has been a standard part of operating rooms for a long time in the form of mobile C-arms, ultrasound, and endoscopy, these minimally-invasive procedures require imaging techniques that can visualize smaller body parts such as thin vessels in the heart muscle and can be facilitated through intraoperative 3D imaging.

Hybrid operating rooms are currently used mainly in cardiac, vascular, and neurosurgery, but could be suitable for a number of other surgical disciplines.^{[citation needed]}

The repair of diseased heart valves and the surgical treatment of rhythm disturbances and aortic aneurysms can benefit from the imaging capabilities of a hybrid OR. Hybrid Cardiac Surgery is a widespread treatment for these diseases.^{[citation needed]}

The shift toward endovascular treatment of abdominal aortic aneurysms also pushed the spread of angiographic systems in vascular operating room environments. Particularly for complex endografts, a hybrid operating theater should be a basic requirement. Also, it is well-suited for emergency treatment.

Some surgeons not only verify the placement of complex endografts intraoperatively, they also use their angiography system and the applications it offers for planning the procedure. As anatomy changes between a preoperative CT and intraoperative fluoroscopy because of patient positioning and the insertion of stiff material, more precise planning is possible if the surgeon performs an intraoperative rotational angiography, takes an automatic segmentation of the aorta, places markers for the renal arteries and other landmarks in 3D and then overlays the contours on 2D fluoroscopy. This guidance is updated with any change in C-arm angulation/position or table position.

In neurosurgery, applications for hybrid ORs are for example spinal fusion and intracranial aneurysm coiling. In both cases, they have been rated promising to improve outcomes. For spinal fusion procedures, an integration with a navigation system can further improve the workflow. Intraoperative acquisition of a cone beam computed tomography image can also be used to reconstruct three dimensional CT-like images. This may be useful for the applications above and also for confirmation of targeting for placement of ventricular catheters, biopsies, or deep brain stimulation electrodes. Intra-operative MRI is used to guide brain tumor surgery as well as placement of deep brain stimulation electrodes and interstitial laser thermal therapy.^{[citation needed]}

Procedures to diagnose and treat small pulmonary nodules have also recently been performed in hybrid operating rooms. Interventional image guidance thereby offers the advantage of precisely knowing the position of the nodules, particularly in small or "ground-glass" opaque tumors, metastases, and/or patients with reduced pulmonary function. This allows for a precise navigation in biopsies, and resection in video-assisted thoracoscopic surgery. Most importantly, using interventional imaging in video-assisted thoracoscopic surgery can substitute for the loss of tactile sensing. This approach also delivers the potential to spare healthy lung tissue by knowing the exact position of the nodule which increases the quality of life for the patient after the operation.^{[citation needed]}