Development of the Hybrid Theatre
A hybrid theatre is a combined operating theatre and interventional radiology suite. The hybrid theatre can function as either a conventional operating theatre or as a radiology facility but crucially allows intra operative and post-operative imaging and intervention, and overcomes many of the limitations of standard facilities.
Vascular services include the treatment of aneurysm and other abnormal blood vessels, limb ischaemia, carotid artery disease, peripheral and visceral arterial disease, thoracic outlet surgery and venous disease. Interventional radiology for vascular disease involves a range of minimally invasive image-guided techniques for stenting and repair of vessels. Many endovascular operations require surgical input, and there are progressively increasing numbers of procedures which are part surgical and part endovascular. Such procedures require full operating theatre specifications with high quality imaging facilities.
Within vascular services there has been a shift in the treatment of Abdominal Aortic Aneurysm (AAA) from Open Repairs to Endovascular Repair (EVAR), where possible and appropriate. Open Repair involves cutting open the abdomen to replace the aneurysm with an artificial piece of artery – a graft. This is a major operation and carries some risk. EVAR involves inserting a stent -graft within the aneurysm through smaller surgical groin incisions using X-rays to guide the graft into place. The advantage of this type of repair is that there is no open abdominal surgery. This technique is therefore safer than the traditional operation and the patient spends less time in hospital. There is always the potential to convert to open repair or perform an emergency bypass graft.
Most interventional radiology suites (based in X-ray) are not designed to incorporate an anaesthetic machine and the additional staff required for a general anaesthetic procedure. Radiology suites often lack the positive pressure, air change cycling ability and environmental control of an operating theatre. Other issues include a lack of optimal lighting and suction facilities if an open surgical procedure is required. Although EVAR complications are rare (3.8%) it is possible that, with the increasing volume of endovascular cases, their complexity and the possibility of ruptured aneurysms during endovascular repair, the need for conversion to open repair may increase. Other procedures requiring a combined surgical and radiological approach, such as femoral endarterectomy and iliac angioplasty will also be undertaken in this setting.
A hybrid theatre is the required option for this complex work with permanent imaging equipment. Theatres are built to allow rapid decontamination cleaning and to promote the optimum sterile environment. The use of portable imaging equipment within an operating theatre may cause a threat to the sterility. In addition the MHRA have advised against the use of mobile intensifiers for EVAR.
There will also be an opportunity for other procedures to be accommodated within the Hybrid Theatre such as complicated obstetric procedures (placental invasion deliveries) and major trauma cases.