Many surgeries can be performed laparoscopically — with small instruments inserted through tiny incisions that allow for faster, safer recoveries. Others can be performed with endovascular methods, with thin tubes inserted into a patient’s veins and arteries. And some still require more traditional methods, with larger incisions and more aggressive efforts to ensure the patient’s return to a healthy life.
Sometimes, surgery requires a combination of these very distinct approaches. With a new hybrid operating suite online at Tanner Medical Center/Carrollton, each of those approaches can be employed at the same time.
“What that allows us to do is bring the patient in for one care event, and perform a diagnostic procedure and convert it to an interventional procedure, and if the patient needs an open operation, then we’re able to convert and do all of that in one operating room, in one event,” said DeNene Cofield, CNOR, a certified perioperative nurse and director of surgical services for Tanner Health System.
Part of the expansion to Tanner Medical Center/Carrollton’s surgical services unit, the hospital now has a $2 million, 900-square-foot (“larger than many Manhattan apartments,” Cofield joked) hybrid operating suite that can easily be reconfigured for a number of procedures on the fly. For surgeons, that capability vastly expands the treatment options they can offer. And for patients — especially vascular surgery patients — it means a higher level of safety and comfort for their procedure.
The ability to perform endovascular procedures at Tanner isn’t new; the hospital has operated a catheterization lab for years, and when Tanner Heart and Vascular Center opened in 2008, it added three new catheterization labs to the hospital’s capabilities.
However, with a hybrid operating suite like the one now available at Tanner Medical Center/Carrollton, surgeons have the ability to convert to a different procedure based on the patient’s needs without having to schedule another procedure at a later time.
The room has eight high-definition computer monitors for endovascular and laparoscopic procedures and four operating room lights for more open operations, all of which can be configured for procedures performed on virtually any part of the body. A 52-inch monitor allows every member of the surgical team to view endovascular procedures so they can better anticipate the needs of the patient and surgeon.
Certain essential equipment — such as video images, X-ray images or ultrasound images — are integrated within the operating suite, allowing any image to be displayed on any of the monitors in the room. Even the table itself is state-of-the-art, allowing a surgeon to tilt a patient if necessary to help follow the irregular pattern of blood vessels with a catheter when maneuvering the instruments alone is unsuccessful.
The need for the new space coincided with the addition of vascular surgery to Tanner’s line of surgical services. When Dr. Glenn Whitney, a board-certified vascular surgeon joined Tanner’s medical staff and established Tanner Vascular Surgery, a Tanner Medical Group practice, it became a priority to ensure that he had the facilities he needed to serve his patients.
“I’ve used a hybrid suite in the past, but this one is exceptionally well-equipped and flexible because of the way its set up,” said Whitney. “In some of the cases that you do, the visibility of the procedure can be limited with other operating suites. It’s like the difference between a 1954 television and the latest LCD 1080p high-definition screen. The better visibility will improve the success rate on even some of our most difficult cases, helping us avoid having to use open surgery. It gives you the best chance of success in a difficult situation.”
Being a hybrid suite, said Whitney, the room also provides more flexibility for the hospital.
“The room is flexible enough that it could be used for a general orthopedic case or a general surgery case if we’re not using it for a vascular case,” said Dr. Whitney.
Vascular surgery focuses on the health and function of the body’s blood vessels, including the veins that carry blood to the heart and arteries that carry oxygen-rich blood from the heart. With cardiovascular disease affecting one-in-three local residents, the availability of a locally based, top-tier vascular surgery program is essential to offering patients a comprehensive continuum of care.
Often, vascular surgery can be performed with endovascular methods, using catheters and stents inside the body’s veins and arteries. However, if the endovascular approach doesn’t work — a blocked artery needs a bypass rather than a stent, for instance — then the kind of surgery being performed changes. It’s no longer so critical to have an array of monitors at the surgeon’s disposal, but lights and equipment to perform a more “open” surgery are necessary.
Surgeons operating in the hybrid suite can make this change quickly during the course of a procedure.
“It provides a level of flexibility that you need to perform some of the latest surgical procedures,” said Cofield. “A surgeon has the option of taking the least invasive route possible to begin with, and can switch to a more open surgery if they find that they must.”
The hybrid suite is the newest, most advanced endovascular operating suite in the Southeast, according to Cofield.
To prepare to use the new operating suite, the surgical services team received extensive training, including training in Cleveland, Ohio for applications training and on-site applications training in Carrollton. The team also has performed “mock-ups” to practice in the space.
“The room is so configurable, that the team had to learn how to operate in the space,” said Cofield.
The expansion that added the hybrid suite also added two other additional operating suites to the facility, bringing the number of operating suites available from seven to 10. Cofield said that the hospital has seen patient volumes continue to rise, coinciding with the expanded space. The other new operating suites are being brought online incrementally as volume requires.
“Carrollton is still a pretty small town, but this is a huge investment for the hospital,” said Dr. Whitney. “It shows that this community appreciates the future of medicine and it shows what the vision is for the hospital — investing in creating a level of care that, just a few years ago, you had to drive an hour or more to receive.”