Lexington, Ky. -Only a handful of hospitals in the U.S. have high tech hybrid operating rooms. As might be expected, these hospitals are the big names in medicine: Johns Hopkins, UCLA, and so forth. Only one hospital in the U.S. has a hybrid operating room that its designers say is better than any of the others. That hospital is the University of Kentucky's Chandler Hospital.
"Most places modified an existing operating room," said Dr Joseph (Jay) Zwischenberger, UK HealthCare's Surgeon-in-Chief. "We're the only ones who designed their hybrid operating room from the ground up."
After convincing UK's Board of Trustees to approve the $35 million for eight new operating rooms, the hybrid OR, and pre and post surgical areas, Zwischenberger and other UK doctors toured the few hybrid operating rooms in existence around the country.
UK's version of a hybrid operating room was designed first on paper, then on computer. Next, Zwischenberger, Dr. Michael Karpf, UK Executive Vice President for Health Affairs, and Dr. Bernard Boulanger, UK Surgical Services Director, had a full-size Styrofoam model of the computer's design built. Surgeons, nurses, and other staffers pretended they were performing actual surgeries within the mockup.
More changes were made. Every employee involved had to participate in the design process and sign a form that he or she had no further suggestions and could foresee no problems.
Because of that extensive design process, UK's hybrid operating room is incredibly versatile. More than one surgical team can operate on the same patient at the same time.
For example, they might repair neurological and cardiovascular problems simultaneously.
A major advantage of such highly-specialized surgery is that the patient has to undergo anesthesia only once.
Another advantage of this collaborative approach to surgery is the chance to develop and learn new techniques from surgeons in other specialties and subspecialties. "That's why Hopkins and Duke are jealous," Zwischenberger said with a smile.
What excites Boulanger most about UK's hybrid OR is "the fact that it was designed around the patient. The most important person is the patient."
Dr. Justin Fraser, UK neurosurgeon, had worked at Cornell University Weill Medical Center with an earlier version of the hybrid OR's sophisticated imaging system. "Even five or ten years ago taking these [extra and detailed] images would have added hours to a procedure," he said.
Keeping a patient anesthetized for that long is, of course, unacceptable. The new imaging only "adds five to ten more minutes," Fraser explained.
The imaging is virtually instantaneous and ready for the surgeons to study. The Siemmens Zeego robot containing the sophisticated cameras stands beside the operating table, an imposing nine or so feet tall.
At the push of a lever it extends an arm to bring its imaging capabilities closer to the patient. The arm can rotate 360 degrees, taking an image at each degree, if needed. It can combine all of those separate images into a 3D image of the patient's body.
Dr. David Minion, UK vascular and endovascular surgeon, said that the 3D image lets surgeons "know what's going on in a patient's body. We can treat with more speed and accuracy."
Minion added that the images captured are stored for later review and for teaching surgical residents. They're even available for doctors at hospitals in other countries.
The hybrid operating room opens for use on February 27. It will be reserved for specialized vascular, cardiovascular, cardiothoracic, and neurological surgeries. Less complex procedures will be performed in the eight new regular operating rooms, starting February 20.
Karpf said that surgeries would also continue to be performed in many of the hospital's older operating rooms. "They're in good shape, but we'll close a few of the smaller ones," he explained.
The need for the new ORs is clearly there. UK HealthCare is now doing 16,000 surgical cases per year and expects to be doing 27,000-28,000 cases soon. More and more patients come from TN, IN, OH, and WVA.
The Post Anesthesia Care Unit (PACU) and the pre surgery area were designed with the comfort of patients and the ease of staff members at work in mind
Immediately before surgery each patient stays in a private walled-off area, with comfortable chairs for family members. Only thin curtains separated patients in the older, smaller pre surgery units.
Karpf sees two important loops related to the new surgery section. He said that the loop of getting trauma patients to treatment quickly includes such components as the rooftop heliport with its adjacency to extra large trauma-only elevators, the operating rooms close to the trauma unit (within the Emergency Department), and a supply of blood already stored in the ED.
"The loop for families is important to us, too," Karpf said. "We wanted an environment that would keep family members calm and comfortable" while they wait.