What is a hybrid operating room?

St. Charles’s new space to reduce invasive surgeries

By Tara Bannow / The Bulletin / @tarabannow

Published Apr 10, 2014 at 12:11AM

A decade ago, having surgery to repair one’s aorta — the all-important artery that brings blood from the heart to the rest of the body — would have required four to five hours on the operating table followed by weeks of recovery, and then probably discharge to a nursing home for physical therapy.

Today, it would be a roughly half-hour procedure, and the patient could go home the next day, said Dr. Wayne Nelson, a vascular and endovascular surgeon with Bend Memorial Clinic.

The ability to perform less invasive and disruptive surgeries, he said, is thanks to cutting-edge technology that’s hit the market in recent years.

“It’s just a night-and-day difference,” Nelson said.

Since coming to Central Oregon, Nelson has been pushing to bring technology to the area to create a top-tier vascular program. On Monday, St. Charles Health System unveiled the final product of its collaboration with Nelson: a hybrid operating room in its Bend hospital. This 1,200-square-foot operating room contains a large imaging system that allows for minimally invasive surgeries for patients with vascular disease, aortic aneurysms or traumatic vascular emergencies.

A hybrid OR allows for catheter-based interventions, meaning a long, thin tube is inserted into the blood vessel in order to both see and perform the fixes internally. Not only do these types of procedures result in smaller incisions, less scarring and shorter recoveries than traditional procedures, but they also increase the number of patients who can be treated, especially the elderly or the very frail, Nelson said.

“Before, if you had a problem like this, nobody was going to be able to take you because you wouldn’t live through the procedure,” he said. “Now, they don’t even notice. I could do the procedure, and it’s just like they don’t even know it’s happening.”

The hallmark of St. Charles’ $5.5 million project is its massive imaging machine: the Allura Xper FD20 by Philips. The machine’s C-shaped arm forms a half-circle around the patient table, allowing for 3-D imaging.

The technology also allows doctors to prepare ahead of time for a trauma patient in, say, John Day. CT scans can be sent instantly, loaded onto the computer and aligned with images of the actual patient once he or she is on the table, providing what Nelson calls a “3-D road map of the patient’s blood vessels.”

The Allura Xper FD20 was among the most commonly purchased imaging machines for hybrid ORs between 2012 and 2013, at 21 percent of all purchases, according to an analysis by the ECRI Institute, a nonprofit that uses research to analyze the merits of medical procedures, drugs and devices. The machine costs an average of $1.5 million and typically makes up half the total cost of building a hybrid OR.

Hospitals are experiencing increasing market pressure to build hybrid ORs like the one St. Charles just unveiled, said Rohit Inamdar, a senior associate with the ECRI Institute’s Applied Solutions Group. Even if smaller hospitals don’t have the current patient volume to support such an investment, they may install them to prepare for what they’ll see in the coming decade, he said.

The trend in health care toward minimally invasive procedures has been going on for years, Inamdar said. Laparoscopic surgery, for example, was introduced decades ago. Now, surgeons are even using robots, such as the one St. Charles Bend purchased in 2012, to perform surgeries, he said.

“These endovascular approaches now in surgery are really ultra-minimal because they go through our blood vessels,” Inamdar said. “They will make an incision either in the groin or the arm and … they can basically go anywhere in the body with a catheter.”

In the rare case that something goes wrong during such delicate procedures, hybrid ORs allow the physician to go into open surgery then and there rather than having to rush the patient to the operating room, Inamdar said.

Another benefit of the hybrid OR is the fact that the Allura Xper FD20 exposes patients to 75 percent less radiation compared with the imaging equipment used previously, Nelson said.

The equipment exposes the patient to less radiation because rather than emitting a constant flow, it pulses for only a small proportion of the time during the procedure, Inamdar said. It may be on for only 30 percent of the time, for example, thereby reducing a patient’s exposure by 70 percent. The pulses happen so fast, however, the eye doesn’t pick up on it, he said.

BMC has hired another vascular surgeon, Dr. Jason Jundt, to work in the hybrid OR with Nelson. Jundt, who graduated from the University of Texas School of Medicine in San Antonio in 2008, will begin in July.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com