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The Multidisciplinary Hybrid OR By Wiebke Kathmann, PhD In 2012 orthopedic trauma, cardiovascular, and neuro surgeons embarked on a common journey at the Ulm University Hospital in Germany – the multidisciplinary use of an Artis zeego hybrid room. AXIOM Innovations met the team to talk about their visions, experiences, and lessons learned during the first year. It all started when a new University Hospital building was built in Ulm in 2012: a center of maximum care with over 1,100 beds and over 5,000 employees. This was Prof. Dr. Florian Gebhard’s fortuitous moment. As the Director of Orthopedic Traumatology, Hand, Plastic, and Reconstructive Surgery, he seized the opportunity and realized his dream of setting up a 3D-roboticimaging system integrated with navigation technology. His vision was to confirm that the combination of systems works for neurosurgery and orthopedic trauma, especially complex trauma interventions of the spine and pelvis. Due to fiscal and room utilization constraints he invited the neurosur- geons, vascular, and heart surgeons on board early in the discussions and as a result the hybrid room was optimized for all specialties. Planning the Hybrid OR When setting-up a hybrid room, taking time for the details of the layout is important, reports Peter Richter, MD, Prof. Gebhard’s right hand man. This is especially true if it is to be used by several disciplines. In Ulm the starting point was a 65 square meter traditional OR with the Artis zeego robotic imaging system as the centerpiece. “In our case this flexible floor-mounted system with 3D functionality and Automap gave us the versatility necessary for multidisciplinary utilization,” stated Dr. Richter. “As for the navigation system, our choice was the Brainlab Curve™. Choosing the other components of the OR, like a laminar air flow, modern OR-table technology as well as large flat detectors for wide patient coverage took quite a while,“ recalled Dr. Richter. Since it had to be ensured that patient positioning, for example, had to meet everyone’s demands regarding workflow, unrestricted access to the patient while also providing substantial space for anesthesia and the additional equipment for other specialties. Communication and Sharing are Key Looking back on their first year, all teams regard communication as key. They advise others who want to embark on the journey of a shared hybrid OR to plan on regular meetings from the beginning. “Clearly, a jour fixe is of great help, ideally with a coordinator taking care of the common needs of all disciplines involved.“ said Prof. Rainer Wirtz, MD, Director of the Clinic for Neurosurgery in Ulm and Günzburg. “That way you can discuss upcoming issues and share experiences – for instance regarding patient draping, data storage, or simple things like anesthetic equipment positioning during 3D acquisition.“ Besides the jour fixe recommendation, predefined rules and a clear schedule for all disciplines involved was considered important by all groups. In Ulm the hybrid room is reserved by the orthopedic trauma surgeons two days a week, the vascular/cardiac surgeons another two days, and the neurosurgeons one day a week. Extra hours originally allocated to other teams could be booked through the coordinator in order to maximally utilize the hybrid lab. Currently, the hybrid room operates weekdays from eight a.m. until six p.m. Surgery Orthopedic Trauma Surgery 62  AXIOM Innovations | December 2013 | www.siemens.com/angiography


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