Go Hybrid! - the magazine
Jacques Marescaux: Different disciplines – same idea: Go hybrid!
Florian Gebhard: The hybrid OR is the best thing you’ll ever acquire

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Here you find every issue of Go HYBRID!, our magazine for healthcare decision makers, available for download.

June 2015 - magazine issue 2 April 2014 - magazine issue 1

Expand your focus on therapy in surgery with Siemens - Go HYBRID!

Different disciplines – same idea: Go hybrid!

“You cannot be the “gold standard” without this new operating room concept”

…says Professor Jacques Marescaux, founder and president of IRCAD and EITS, describing the scope of hybrid ORs. In his opinion, the hybrid OR today is best suited for digestive surgery,

urology, gynecology, thoracic surgery, vascular surgery, and cardiac surgery. And he assumes that patients will be asking for less invasive approaches more frequently in the future.

It’s all about value

“We wanted to increase our capacity within our current space”

…remembers Todd Kranpitz, Executive Director of Radiology, Iowa Methodist Hospital, Des Moines. His plan: combining some CT procedures with angiography procedures in order to increase patient volume.

The result: Six months after the installation, the Iowa Methodist Hospital has increased its volume from 530 patients to almost 630 patients with the same staff and no additional overtime.

A climate of cooperation

“If a service is available for interdisciplinary use, it will be welcomed”

… says Irmtraud Gürkan, Commercial Director and Vice-Chairwoman of Heidelberg University Hospital. In her view, it is the duty of a university hospital to provide maximum care and high-performance medicine. Heidelberg is prepared to cross-subsidize innovations in order to advance medicine

and substantially improve her hospital’s quality of service. Fostering a culture of interdisciplinary collaboration at her facility and making special methods available to other hospitals is especially important to her. The concept of the Hybrid OR met these requirements.

Top strategies from purchasing experts

“Careful planning is key, especially for smaller hospitals”

… say the project planning experts from the joint purchasing association AGKAMED, Essen, Germany. Adam Pawelek, head of the purchasing department, and CEO Dr. Oliver Gruendel explain that a

Hybrid Operating Room can pay off well for small and medium facilities, given a handful of basic conditions: good planning, multidisciplinary use, and cross-departmental cooperation.

Well equipped to meet the future

“From the start, we attached great importance to a very interdisciplinary orientation”

… says Dr. Thomas Grueneberg, manager of finance and administration of the Cardiovascular Center at Nuremberg Hospital, Germany. From the very beginning of the hybrid era, they formed a “heart team” in which cardiologists and heart surgeons work together and a “vascular team” where vascular surgeons work with the interventional radiologists.

The whole concept makes Nuremberg very interesting to other disciplines. The vascular surgeons conduct regular workshops where they show the Hybrid Room in action. A second Hybrid OR is already planned.

New fields of application

“We have to be where the ash is still hot”

…says Chairman Dr. Alfred Estelmann, who represents the maximum-care hospital in Nuremberg. His team is interested in offering the latest technology and the latest medical services to patients.

Today there are four disciplines gradually developing new possibilities for utilizing the Nuremberg Hybrid OR. And it will be worthwhile to open up this field of application to even more departments.

The Hybrid OR as a flagship project

“I’m sure we’ve profited significantly in economic terms”

… says Dr. Andreas Kestler, CEO of the Hospital of the Order of St. John of God in Regensburg, Germany. His team started out with the basic set of Hybrid OR equipment and continued to add various appropriate modules. The economic risk was entirely manageable.

But as a doctor and as a businessman too, he knows that most things that seem plausible don’t have to be calculated out to the last decimal place. That’s why the Regensburg team classified the investment in a Hybrid OR as a flagship project.

Artificial intelligence changes everything

“Maybe in 20-30 years you’ll have automatic surgery”

…says Professor Jacques Marescaux, founder and president of IRCAD and EITS and CEO of IHU Strasbourg. In his opinion, we are still in the prehistory of robotics today, because robots offer only a small improvement to a surgeon’s capacity.

But he sees another advantage of artificial intelligence: A robot interface can analyze “1,000 signals” per second, and the combination of imaging and the capacity of the robotic system could truly result in the ideal operation.

Five important factors in setting up a hybrid OR

“I believe that these hybrid ORs can definitely be of benefit to the field of healthcare as a whole,”

… says Dr. Dittmar Boeckler, doctor of vascular surgery at Heidelberg University Hospital. He considers the hybrid OR to be a sine qua non in the area of vascular surgery at university facilities and maximum

care facilities, because they are increasingly moving away from conventional surgery toward endovascular treatment. He presents five strong arguments to support his opinion.

Being part of a vision

“Robots and precise imaging will enable us to work more gently and with less trauma,”

… says Dr. Dittmar Boeckler, doctor of vascular surgery at Heidelberg University Hospital. His vision for vascular surgery of the future is that multiple stand-alone components will become integrated as part of a single hybrid OR.

He believes that in the future, vascular surgeons will be able to direct a robot from outside the radioactive field, away from exposure to radiation, and will routinely perform minimally invasive surgeries on patients using fusion imaging and navigation.

Making change happen in surgery

“I really believe that image-guided surgery is leading to fewer complications and better surgical outcomes. And that will definitely offer hope to patients”

… says Dr. Georg Nollert, Director Global Marketing Operating Room, Siemens AG. Surgery is changing rapidly, according to his observations. Some surgeons think that change is far off, because the new methods first have to be proven by long-term outcomes.

Other surgeons are already making the change happen – they are pioneering new image-guided procedures.

WebSurg – the virtual surgical university

“Complete training is key when introducing a hybrid OR”

… says Professor Jacques Marescaux, who launched the virtual surgical university “WebSurg.” The goal of this unique online platform is to provide the surgical community, scientific societies, medical teaching

centers, and industries with the first worldwide online training in surgery, information on the latest surgical breakthroughs, and the ability to chat with experts from all over the world.

Optimal safety for your patients

“The hybrid OR is the best thing you’ll ever acquire”

…says Prof. Dr. Florian Gebhard, Medical Director of Trauma Surgery, University Hospital Ulm. In his opinion, the hybrid OR provides patients with the greatest safety available, because all implant positions

can be controlled intraoperatively in 3D. The result: No patient leaves this type of OR with a misplaced implant, because that is recognized immediately.

The hands-on training experience

“Hybrid OR training cannot be accomplished with lectures alone”

…says Prof. Dr. Florian Gebhard, Medical Director of Trauma Surgery, University Hospital Ulm. That’s why the trainees in Ulm do not participate in the daily hospital routine, but rather stay all day in the hybrid OR

–focusing only on this type of surgery. This is quite different from other fellowship programs, but it is truly successful.

A benefit for the economic side of healthcare

“It is only this kind of precise navigation that ultimately makes a good clinical result possible,”

… says Dr. Dittmar Boeckler, doctor of vascular surgery at Heidelberg University Hospital. He is convinced that improved imaging is directly reflected in the outcome of the treatment process. He explains that having precise navigation equipment in the OR means less surgery

– less need for repeat operations and interventions – and leads to fewer complications. He believes that there will be a long-term benefit from the technology – and not just for the patients.

Paradigm shift in emergency care

“We can provide the necessary emergency care without losing time, either with an intervention or with surgery if necessary”

… says Dr. Markus Steinbauer, head physician of vascular surgery in Regensburg’s Hospital of the Order of St. John of God. After initial diagnostics and stabilization in the emergency room, patients with critical circulatory malfunctions or bleeding are taken straight to the OR, where the necessary diagnostics can be performed.

That process has meant an immense time advantage for patients with critical ischemia or ruptured aneurysms. What’s more, there are fewer complications with these patients because they can get care faster.

Quality is freedom of choice

“For me, high quality means always providing our patients with the best treatment. And the Hybrid OR gives us the opportunity to select the best treatment for each individual patient”

… says Bernd Sahner, commercial director of the University Heart Center, Freiburg-Bad Krozingen. In his opinion, just being able to choose between two treatments is a basis for top quality.

Another key aspect of top quality is good communication between the manufacturers and users. Siemens Leasing provided Sahner with valuable consulting and much-needed flexibility.

Unmatched position flexibility

“The Artis zeego robotic angio system has been specifically designed for hybrid operating rooms”

… says Dirk Sunderbrink, Global Marketing Manager Surgery, Siemens AG. Thanks to its unique position flexibility, Artis zeego is the perfect system for modern operating rooms.

In combination with the OR system tables, 3D image-guided procedures in many surgical disciplines can be supported.

Endovascular Hybrid OR

Artis Q floor-mounted system

The Artis Q floor-mounted system offers high positioning flexibility on a very small footprint. The C-arm features a floor rotation point with motorized swivel – from the head-end position to a left-side position. This ensures optimal access to the patient’s head as well as extensive coverage from head to toe. Flexible positioning of the C-arm relative to the table is also possible, for example, to allow access to the

patient’s left side for pacemaker implantations. A special orthogonal position with rotated table enables easy access to the patient’s head and sides for hybrid procedures. Artis StraightView maintains upright images for all C-arm and table positions. The compact and slim-line C-arm design has a small footprint that requires an examination room size of just 25 square meters.

Project Hybrid OR – the milestones

“Get everyone on board with the project as early as possible”

… says planning expert Prof. Dr. Clemens Bulitta. The design of a complex OR infrastructure is determined by the required clinical applications.

But by taking defined steps from team-building to sign-off, the challenges can be mastered.