First Year Experience using an Interdisciplinary Hybrid Operating Theater for Spinal Surgery in a Level 1 Trauma Hospital

Abstract

Introduction An interdisciplinary hybrid operating theater was established in June 2012 at the University of Ulm. A floor-based 3D flat panel robotic C-arm (Artis Zeego, Siemens, Germany) is connected to the operating table and the ceiling-based navigation system (BrainLab Curve, BrainLab, Germany). The robotic C-arm is controlled by the surgeon through a control panel mounted on the operating table in the sterile field. The large field of view of the flat panel C-arm allows visualization of the entire lumbar spine or pelvic ring with a single intraoperative 3D scan. This operating room is shared by four different disciplines (orthopedic surgery, neurosurgery, vascular, and cardiac surgery). This hybrid setup represents an advanced imaging and navigation system, and is the first of its type. Material and Methods We included all orthopedic surgeries performed in the hybrid operating theater during the first year. All the cases were reviewed for postoperative complications. Results A total of 92 cases in 91 patients were performed in the first year. Posterior stabilization of the spine was the most common procedure (57.6%) followed by sacroiliac screws (13%). Other procedures included tumor resection of the spine or pelvis, kyphoplasty, and fixation of acetabular and extremity fractures. Overall, 51.1% of the cases used navigation and 46.7% a minimally invasive technique. Complications included four postoperative seroma and two consecutive infections. All seroma and infections occurred in tumor resections. In large tumor resections, two neurological deficits were detected. Another patient developed dysphagia after fixation of an odontoid and atlas fracture. Conclusion None of the complications occurred because of the use of the hybrid operating theater instead of a conventional operating theater. The hybrid operating theater combines high quality, large field intraoperative imaging with advanced navigation. This results in a higher surgeon confidence in hardware placement and total tumor resection. The control panel mounted on the operating table enables the surgeon to operate this complex imaging device in the sterile field. The interdisciplinary use of the operating theater optimizes utilization.