Hybrid Operating Room Streamlines Lung Cancer Treatment

A new study describes how integration of cone-beam computed tomography (CT) scanning and hybrid operation room (OR) technology has caused a paradigm shift in thoracic surgery.

The Medical College of Georgia (MCG; Augusta USA) hybrid OR, inaugurated in May 2017, brings together three surgical techniques into a single space: cone-beam CT scan augmented navigational bronchoscopy, cone-beam CT-guided percutaneous biopsy and/or fiducial placement, and fiducial or image-guided video-assisted thoracic surgery resection. The single-stage procedure allows for diagnosis and treatment in one setting, with rapid on-site evaluation of cytology or pathology specimens a key element of the “all-in-one” approach.

By using intra-operative cone beam CT imaging technology from a single provider, Royal Philips, the time from diagnosis to curative treatment is significantly reduced when compared to a traditional operating room, leading to decreased upstaging, increased patient survival, and simplifying the otherwise difficult intraoperative detection and resection of smaller and deeper lung cancer lesions.

For the study, the researchers compiled data from 25 patients and reviewed the medical charts of 11 others. Each of those patients underwent a same-day bronchoscopy, CT-guided biopsy, and surgical resection, if indicated, in the hybrid OR. Of the 11 patients, 10 had a successful diagnosis in one setting, with six diagnosed with cone beam CT-guided biopsy. Four of the six patients then went on to have a surgical resection of the cancerous nodule removed. The study was published on August 17, 2018, in Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery.

“The reasoning behind using the hybrid OR is to present a more efficient workup and treatment process to ultimately benefit patient survival. We can do that by shortening time from diagnosis to treatment while increasing cost-effectiveness and optimizing utilization,” said lead author thoracic surgeon Carsten Schroeder, MD, of MCG. “Before I started using the hybrid operating room, it could take up to six weeks just to get a diagnosis. Having the hybrid OR and all of its technologies allows me to tailor the patient's care plan in one day, instead of having to schedule multiple follow-up appointments.”

In a Hybrid OR, advanced diagnostic imaging equipment is used to create a multidisciplinary space that allows different specialties to work together in order to diagnose and treat patients in the same location, as well as perform both open and minimally invasive procedures. The advanced room design allows for a patient to transition from an interventional to a surgical procedure without needing to be transported to another setting, allowing for reduced time in the OR setting and improved clinical outcome for patients.

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