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Integration, hybridtechnology steal theshow

Surgical tables and lights maystill be the star attractions in theoperatingtheatre, but in todays fast-paced,state-of-the-art surgical suites,high-tech digital integration andhybrid functionality gets top

billing.

"OR Suites have evolveddramatically from those of adecade ago, owing largely to thedramatic growth of MIS[minimally invasive surgery]

procedures across surgical fields,"commented Randy Tomaszewski, vice president of marketing, SKYTRON . "In addition, the advancement of video,data and telecommunications within the OR to providing critical patient data at the fingertips of the surgical team(PACS, EMR, video images and more) has been a tremendous advantage in improving clinical workflows, staff andoperational efficiencies, as well as the quality of patient care."

Accompanying the trend towards minimally invasive, natural orifice, as well as robotic procedures, "integratedoperating rooms are becoming the standard for quality patient care," remarked Lauren Ashley, marketing associatefor Stryker Communications. "With advances in surgical technology, hospitals are utilizing this integrated platformto maximize efficiencies, increase the level of patient care, and minimize cost of ownership."

"Hybrid" suites are also becoming the norm, observed Jim Norris, senior manager, market development, STERISCorporation . "We see basic OR suites evolving into a combination of advanced ORs and general surgical rooms. Asmore procedures become minimally invasive (whether via an endoscope, a robot or trans-catheters), OR designersneed to accommodate these new technologies by developing flexible room designs. High definition (HD) cameras,HD monitors, intra-operative imaging, 3D image capabilities and robotics are transforming patient care. Surgicalroom design must take all these advancements into consideration, and facilities must look into the future in order tomake the most of scarce capital funds."

Through its OR SuperSuite expert design services, BERCHTOLD Corporation has completed hundreds of designsfor hybrid suites that combine a typical surgical environment with diagnostic imaging/interventional capabilitiesranging from ceiling mounted C-arms, to CTs and MRIs, described Matthew Weismiller, president. "What wereseeing today on larger projects is that the hospital will build two hybrid suites for every 12-15 standard suites. Andwe believe that ratio will continue to grow as surgeons perfect the use of imaging technologies in the surgicalarena."

According to Steve Palmer, director of marketing, TRUMPF , "the definition [of a hybrid room] can rangedramatically, but its basically bringing high-end imaging and surgery together in the same room. Now everythingcan be done in sequence without having to wait."

Generally speaking, operating suites that are flexible or "universal" are becoming increasingly popular, indicatedPalmer. "Because technology and surgical procedures continue to evolve fairly rapidly these days, they dont want aroom thats dedicated to one specific discipline, e.g., orthopedics or neurosurgery. They want to be able to use theserooms with as many disciplines as possible."

SKYTRON-Philips Hybrid Room Suite featuring Philips interventional X-ray imaging.
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Eric Berger, marketing coordinator for ConMed Integrated Systems , noted several trends in surgical suites,including: "Larger suites to accommodate multi-specialty procedures and auxiliary equipment; most new suites willimplement boom solutions; most new suites will be HD-ready for digital integration and documentation; hybrid(interventional) ORs that can address surgical procedures as well as angiography; navigation and robotics are part of the integrated OR with greater frequency; open systems and interoperability of devices; and more integration withEMR, data management and archiving."

A Philips-STERIS hybrid suite

Commenting on the growing size of ORs, Tomaszewski, SKYTRON, noted, "A decade ago, ORs were typically 400square feet. Older operating rooms commonly have even less space. Today, the minimum requirement for newconstruction is 600-800 square feet. For specialty ORs, such as cardiovascular and orthopedic suites, even larger foot prints are the norm. Why? Because with the growth and advancements of surgical technology and equipmentcommonly used today, smaller rooms would leave no room for the patient and clinical staff. Robotics, C-arms, videocarts, microscopes and more that make surgeons so proficient also require far more space. The general OR rule of thumb is, the smaller the wound, the larger the room," he said.

A desire to increase square footage is one of the key reasons that facilities choose to renovate their existing surgicalsuites. Weismiller, BERCHTOLD, explained, "As technology has advanced in the surgical arena, the space requiredfor a fully capable and flexible suite is larger than in the past."

In addition, "the organization and workflow required to deploy the myriad technology while maintaining the sterile

field, that has changed over the years as well," he said. "Creating a workflow in the rooms that approachesmaximum efficiency as well as maintaining all of the appropriate infection prevention criteria, thats demandinglarger rooms and creative new room designs."

"Todays healthcare structure increasingly focuses on quality, safety and prevention," said Donna Ungvarsky, business development specialist, Olympus EndoSite Consulting . "Keeping this in mind, few aspects are as critical inaffecting the success of a healthcare facility as its workspace structure and flow patterns. Very often, unit design andsupport services no longer adequately keep pace with the current and projected growth in volume, change in

procedure mix and/or other current trends in the healthcare arena."
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MacBethPhoto.com

BERCHTOLD SUPERSUITE

Integration and the digital OR

With the growing number of collaborations between interventional radiology and diagnostic imaging technology providers and surgical suite vendors, integration is becoming a seamless operation.

"ORs of today demand integration technology within the OR that delivers speed of access, accuracy, reliability, easeof use, flexibility, OR up time, future proof expansion and more," said Tomaszewski. "Advanced integrationtechnology improves clinical support processes and workflow solutions both within and outside the operating roomvia video and data display in and around the surgical field, linking the operating room with pathology, radiology,cath lab, ICU, interventional radiology, with C-arms, robotics, teleconferencing and more. Booms and surgicallighting play a key role forming the backbone of the integration framework required for key delivery of locations inand around the surgical field, to the main communications hub for access and routing of critical video and dataimages within and outside the surgical suite."

Noted Ungvarsky, "When thinking of integrating your operating/procedure rooms, you must first thoroughlyexamine your needs and determine what you want integration to do for you. You will need to look at the people,

processes and technology that will create the system that will best accomplish your goals. The best possibleoutcomes with integration are a combination of process change (the elimination of waste in the process), trainingand technology. The best technology in the world can only have real impact if the people who use it buy into it andthe processes applied are utilized to their fullest capacities."

For successful integration projects, "buyers and planners should understand the goals of the end users; know thehospitals five year plan for the operating rooms; focus on purchasing equipment that complies with current videostandards; and select regulated medical devices for the OR, not simply audio/video equipment," advised Ashley,Stryker.

"An OR integration system should be vendor-neutral in order to ensure the best images and data exchange possible,"recommended Rich Schafer, director of project design and planning, STERIS. "Also, its important that OR integration systems are able to link to other rooms with integration as well as to other departments and softwarewithin a hospital."


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With integration capabilities ranging from "simple cabling through connection plates on the booms to a verysophisticated HD integration system which can include on-site and off-site conferencing," described Berger,ConMed, he stressed that "the facility needs to be prepped and ready to embrace future technology."

ConMed Smart OR

Surgical suite planners should understand the various levels of integration options available, said Tomaszewski. "A basic integration system enables clinical staff the ability to route video images within the operating room to LCDflat panel and wall-mounted displays. Most of these are considered entry level systems and often times are notupgradeable or expandable in functionality," he cautioned. "Buyers should be aware of this as these systems may be

priced within a desired budget they may not meet the functional requirement and goals of the facility.

"The next level above these entry level systems is an advanced integration system which offers the equivalentfunctionality of the entry level system, but these systems provide a platform for growth both in the number of videoand imaging devices which can be managed as well as adding optional features such as image capture, recording,streaming, music accessories, hands-free phone, video conferencing and more."

Digital technology, such as with Skytrons SkyVision Hybrid II digital integration system, provides additionaladvantages, described Tomaszewski. "There are several integrated ORs today and many of them are based on older analog technology. Some are a mix of analog and digital technology and recently, the all digital integration systemshave been implemented.

"Digital OR communications takes OR communications to the next level of flexibility with greater speed of access,accuracy, reliability, OR up time, future proof expansion, HD digital image quality up to 1080p over IP, optimizingclinical use, workflows and efficiencies," he explained. "Digital Capture Streaming, for example, simplifies audioand video communication over IP from the OR to any remote destination such as conference rooms, another operating room, physicians office or other healthcare facility."


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According to Ashley, "There are many key attributes critical to a successful hybrid suite including: Room layout The hybrid suite should accommodate imaging, surgery, or imaging during surgery; Multiple displaysDue to thevast number of video sources, consideration should be taken to accommodate more than one simultaneously; Videorouting deviceThe suite should have the ability to route any source to any display without distorting (upscaling)the image."

Future-proof suites

While its impossible to predict exactly where surgical technology is headed, there are several ways that facilitiescan build their OR suites to be "future-ready."

"Technology advances very rapidly, so flexibility is key," reinforced Weismiller. For example, he described how amodular ceiling grid system can allow for easy repositioning of equipment mounts compared to traditionalequipment mounts that are welded into the structure above the ceiling. "If four years after you build your suite youdecide you want to convert it from an endoscopy room to an orthopedics room and you want to move your equipment, we can do it. And we dont have to come in with a torch and cut all your welded frames out of theceiling. We can go in after the last surgery on a Friday, and in a couple of days, we can move the lights and booms."

Also, he noted, "every equipment boom that we ship has two empty conduits in it so that, if in the future thecustomer says, I need to upgrade my video cable and add ethernet, we already have the conduits in place, soliterally in a day, we can pull a new circuit and give them new capability."

In addition to "ceiling grids" that allow equipment to be easily moved without extensive construction downtime,Palmer explained how the TRUMPF Clean Operating System featuring pre-fabricated wall and ceiling panels not only provides unique infection prevention benefits, but can also make it easier and less expensive to reconfiguresuites down the road. With the TRUMPF Clean Operating System, panels are cut to the exact size, screwed into thewall studs, and the seams filled with a water-proof gasket. Windows, wall controls, flat panel monitors, etc., are allrecessed into the panels to provide a durable, flush surface thats easy to clean.

"With these wall panel systems, because theyre modular in design and pre-fabricated...it simplifies the long termupgrade capability, in terms of down time and cost involved," said Palmer. For example, if a facility wanted to add a50-inch LCD screen, or additional electric outlets, instead of shutting down the room to knock out a wall, a new

panel can simply be screwed into place. The Clean Operating System has been in use outside the U.S. for manyyears, and TRUMPFs first U.S. installation is scheduled to be completed by late summer at Roper St. Francishospital in Charleston, SC.

MAQUETs VARIOP system is a prefabricated Modular Wall & Ceiling System that has been used in Europe for over 25 years, and was launched in the U.S. over a year ago with an installation at Spartanburg (SC) RegionalMedical Center. The rooms are built in MAQUETs factory in Germany, shipped to the U.S., and assembled onsite.When modifications need to be made, panels can be removed from the walls and replaced with minimal constructiondowntime. In addition, the rooms can be reconfigured to accommodate renovation and expansion needs.


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An OR suite inside the Clean Operating Room System at TRUMPFs Design & Innovation Center.

According to Schafer, STERIS, "Selecting technologies that are modular and upgradable will provide the best abilityto adapt to future requirements. The ability to add modular devices such as HD cameras, surgical-grade monitorsand additional lighting to existing support systems allows the hospital to make modifications less expensively andmore quickly."

Ashley, Stryker, advised, "Request additional conduit runs, request additional ceiling structure, and purchase an OR control system that is easily upgradeable (the easiest systems to upgrade are those that are board integrated, not rack mounted)."

Berger, ConMed, noted that future-proofing an OR suite includes "correct planning of boom placements; wiring for total HD imaging, EMR, PACS and other hardware/software solutions; and staying current with emergingtechnologies and the regulations that may affect them."

Skytrons SkyVision Hybrid II fully fiber optic digital integration system with its "plug-and-play" capabilities,allows for todays HD digital sources as well as older, previous technologies to be connected to the integrationsystem via a single strand fiber cable. Future adaptability is seamless with swap-out expansion ports for simpleupgrades.

Mission-critical planning

As Weismiller described, "There is no area that is more dynamic and ever-changing" than the operating suite. "Itsvery chaotic, and when you design that environment, you have to create an environment thats going to work fromthe 6am start to 7 at night, and just go all day and do everything you want it to do and thats a tough thing to do.Its without a doubt the most challenging area of the hospital," he stated, adding, "The technology in a room is socomplex, if you dont do the early design process properly you can easily end up with a room that youre verydissatisfied with."

Vendors all agreed that the best approach is a team effort guided by key hospital staff who have a goodunderstanding of the hospitals mission and care objectives. "You have to assemble all the right user community


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from the hospital to identify all of the current needs, and whatever can be anticipated for the future," saidWeismiller.

Schafer advised, "Its important to establish clearly defined functional and budgetary goals, since this will reduce thenumber of iterative design steps and will assure that the space thats created works for everyone."

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