Surgery in hybrid OR: Joining forces for better care

Learn how the unique hybrid operating room setting at Hospital da Luz in Lisbon, Portugal allows for better collaboration between surgeons of different disciplines, how that impacts the treatment of patients ... and what surfing has to do with it.
Andrea Lutz
Published on August 21, 2023

“In surgery, it’s the best feeling to get a great result. And a great result means resecting a tumor completely, clipping an aneurysm perfectly, and having the patient wake up and being completely normal,” says Domingos Coiteiro, MD, Head of Neurology at Hospital da Luz in Lisbon, Portugal.

For Coiteiro, a passionate surfer who sees numerous parallels between surgery and sports, it’s crucial to plan and perform a tumor resection with the greatest possible accuracy – just as he is aiming to perform in his sport. And accuracy in the hybrid operating room means being able to correct imprecisions right away.

A hybrid OR is a specialized surgical suite that combines advanced imaging technology – like angiography, CT and MRI – with traditional surgical equipment. It allows surgeons like Coiteiro to take real-time images during an operation and make adjustments as needed. The effects can be lower revision rates in spinal fusion surgery and for certain brain tumors the resection can be more complete.

Because Hospital da Luz in Lisbon has doubled from eight to 16 operating rooms in recent years, the da Luz team had the opportunity to completely redesign the concept of their ORs and how the disciplines work together. Today their hybrid equipment is unique in southern Europe: It integrates robotic angiography and an intraoperative MRI. The advanced imaging technology enables real-time imaging during complex surgeries.

The hybrid system enhances patient care by offering a platform for medical professionals with different expertise to work seamlessly together. The neurosurgeons and thoracic surgeons at da Luz now perform procedures in the hybrid environment and can assess the results intraoperatively. Neurovascular procedures can be conducted alongside traditional open surgical procedures. 

And in addition to increasing the quality of their own resources, the departments also plan to develop new methods in the hybrid OR and to share their expertise: Once a procedure has been established and proven, it can be exported to the other departments in the hospital and to other clinics at Luz Saúde.

The challenge in brain tumor surgery is to maximize the extent of resection while preserving neurological function. In September 2022, Domingos Coiteiro performed their first surgery using intraoperative magnetic resonance imaging in Lisbon. He believes that the hybrid operating room increases responsiveness and surgical efficiency – especially in cases of brain tumors – by allowing him to operate using images of the brain taken in real time and assess tumor margins and possible remnants intraoperatively. The goal is to resect a tumor as completely as possible.

The challenge at the thoracic surgery department at da Luz is to treat small lesions that will become lung tumors in the future and thereby improve patient survival. The hybrid OR offers a great benefit to Fernando Martelo, MD: His team now can perform the localization of small nodules with the patient already anesthetized and positioned on the operating table. Hear from Fernando Martelo how this benefits both the surgeons and patients:
For CEO Isabel Vaz, planning is extremely important. And that’s why she’s brought all types of expertise together at one table. Her strong belief: “Only if you’re all looking in the same direction will you get the best results.” That fusion of minds of managers, surgeons, and engineers has shaped a collaborative organizational culture at Hospital da Luz.

... about the team at Hospital da Luz and their unique hybrid OR setting.

In February 2014, Luz Saúde became Portugal’s first exchange-listed private company in the healthcare sector. 

Entrance building of Hospital da Luz

The group operates 14 private hospitals and 13 outpatient clinics, including the Hospital da Luz in Lisbon. The da Luz team is constantly looking for innovative and effective methods for transforming healthcare, always with the goal to provide the best possible care and outcomes for their patients. Today the extensive experience of its clinical staff and its leadership in technological innovation make Hospital da Luz one of the leading hospitals in Europe.

By Andrea Lutz
Andrea Lutz is a journalist and business trainer specialized on medical topics, technology, and healthcare IT. She lives in Nuremberg, Germany.