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New Approach with a Multidisciplinary Concept Per Wessberg, MD, an orthopedic trauma surgeon at Sahlgrenska University in Gothenburg, Sweden, is also part of a multidisciplinary concept. The vascular surgeons and interventional radiologists constructed a hybrid operating room in 2011. Coming from a mobile C-arm system, he was not aware that the Artis zeego could be used for the spinal cases that are his specialty. He was astonished by the large field of view and the speed of the syngo DynaCT. He focusses on adolescent scoliosis and he believes that the patients benefit greatly from this new environment. After a steep learning curve, once using the system he was also able to speed up the workflow compared to a conventional OR. In Japan, at Tokushjukaj Fujisawa hospital, Sohei Ebara, MD, is using the Artis zeego for spine surgery only. A new spine and scoliosis center was opened with a hybrid operating room dedicated for these cases. Dr. Ebara provides surgery for all parts of the spine, cervical, thoracic and lumbar, and has developed workflows and accessories to fulfill the requirements for the different surgeries and the different surgical positions. As an example, for cervical cases a head clamp is attached to the operating table and the patient is positioned head first in prone position. For the lateral approach in scoliosis the patient is positioned on the side and Dr. Ebara uses endoscopes for better access to Contact ina.schwabenland@siemens.com the thoracic spine. In this case the involvement of the anesthesia and OR staffs are even more critical. He performs approximately seven to ten cases per week and has a fourmonth wait list for patients. It has taken time to gain experience with Artis zeego, and required open mindedness at the beginning but the effort was worthwhile as patients can be treated with greater peace of mind (Fig. 3). Serving the Patient Better These three doctors are great examples of the use of hybrid operating rooms in new fields of surgery. At conferences, through marketing material, and through these ambassadors the word is spreading in the community. The relationship with the AO Foundation, the largest community of orthopedic surgeons with over 30,000 members, is a great platform to expand this new imaging device for highly sophisticated procedures. One of the biggest challenges is to increase awareness that such a system is also available for orthopedic trauma surgeons. The concept of integrating an operating table with the imaging system has proven to be very good. Not only sophisticated patient positioning can be achieved without impairment of 3D imaging but also the shuttle function is very important. First, the patient is positioned on the shuttle once he enters the OR environment – this is due to hygienic regulations. But the shuttle function is also very important for trauma patients. For example, polytraumatic patients can be positioned on the shuttle right on their arrival at the hospital. They can be treated in the emergency room, then go to diagnostics and finally to the OR without having to reposition the patient again. This can truly reduce the workflow by saving time and also avoid thr harm that could be caused by repositioning the patient on different beds (Fig. 4). Surgeon’s Freedom With the extraordinary flexibility of the Artis zeego it leaves the surgeon freedom and access whenever he needs it. More workflows are being developed as the demand and the use of the system increase. Computer assisted surgery with the combination of navigation systems and other robotic systems are evolving, making this a very exciting field for the future. 3D robotic imaging in orthopedic and trauma surgery 3B 4 Orthopedic Surgery AXIOM Innovations | December 2013 | www.siemens.com/angiography  61


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