High-tech hy­brid OR opened at Abing­ton

The Globe - - POLICEREPORTS - By Linda Finarelli

A long­time wish list item for some Abing­ton Me­mo­rial Hospi­tal sur­geons is chang­ing the way some con­di­tions can be treated.

The new $3.5 mil­lion hy­brid op­er­at­ing room pro­vides spe­cial­ists with the abil­ity to per­form catheter-based, min­i­mally in­va­sive work and full sur­gi­cal in­ter­ven­tions in one place, al­low­ing for more team­work and the treat­ment of more com­plex cases, ac­cord­ing to two who lob­bied for the fa­cil­ity, vas­cu­lar sur­geon Dr. Terry Sul­li­van and car­dio­tho­racic sur­geon Dr. Mau­rico J. Gar­rido.

The room is de­signed to al­low vas­cu­lar sur­geons, car­dio­tho­racic sur­geons, in­ter­ven­tional car­di­ol­o­gists, neu­ro­sur­geons and neuro-in­ter­ven­tion­al­ists to work to­gether, ac­cord­ing to a press re­lease from the hospi­tal.

It al­lows for “two dif­fer­ent ways of work­ing on a body us­ing the same place at the same time,” said Gar­rido, sur­gi­cal di­rec­tor of the hospi­tal’s Heart Rhythm Cen­ter.

“For the last decade or so there’s been a trans­for­ma­tive, quiet rev­o­lu­tion in the way we care for vas­cu­lar pa­tients, with more pro­ce­dures us­ing min­i­mally in­va­sive tech­niques,” said Sul­li­van, di­rec­tor of vas­cu­lar surgery ser­vices. Some are hy­brid pro­ce­dures in­volv­ing both open surgery and catheter­i­za­tion tech­niques us­ing so­phis­ti­cated imag­ing with X-ray guid­ance.

The hy­brid OR “pro­vides the best of both worlds,” Sul­li­van said; “a high-qual­ity imag­ing sys­tem in an op­er­at­ing room set­ting with steril­ity and anes­the­sia ca­pa­bil­ity.”

“It al­lows us to do in a more ster­ile set­ting cases with a much higher de­gree of com­plex­ity,” he said, such as an aorta aneurism re­quir­ing de­tailed imag­ing and open surgery ca­pa­bil­ity.

An aneurism oc­curs when the wall of an artery thins, pos­ing a risk of rup­ture, which can cause fa­tal bleed­ing, the Fort Washington res­i­dent said. By in­sert­ing a cov­ered stent with X-ray guid­ance, the aneurism is no longer un­der pres­sure so it stops grow­ing, Sul­li­van said.

In the past, a huge in­ci­sion would be made in the chest or ab­domen to place a stent, re­quir­ing a longer and more painful re­cov­ery, he said. To­day, a min­i­mally in­va­sive pro­ce­dure us­ing guide wires to de­ploy a stent re­quires a 2-inch in­ci­sion in the up­per thigh, re­sult­ing in less pain and much quicker re­cov­ery.

The hy­brid OR “al­lows us to use a more team ap­proach with car­dio­vas­cu­lar dis­eases,” he said, and “im­proves pro­fi­ciency and ul­ti­mately the out­comes.”

A team ap­proach would in­volve aorta prob­lems in the up­per tho­racic re­gion, where there may be car­diac is­sues, Sul­li­van said.

“It al­lows us to treat the con­se­quences of dissections” — a split in the wall of the aorta, “faster and bet­ter,” Gar­rido said.

The room also has a “far su­pe­rior” imag­ing sys­tem,” al­low­ing doc­tors to “do pro­ce­dures with a higher de­gree of pre­ci­sion, cer­tainty and safety,” Sul­li­van said. It also re­duces the amount of ra­di­a­tion ex­po­sure to pa­tients and staff.

State-of-the-art imag­ing tech­nol­ogy, in­clud­ing 3D mon­i­tors that al­low for over­lay­ing MRI and CT scan imag­ing pro­vide a sur­geon with a 3D view “while try­ing to put a stent in place,” Sul­li­van said.

“It max­i­mizes the abil­ity to see well for min­i­mally in­va­sive heart surgery,” Gar­rido added.

Sul­li­van said he lob­bied for the hy­brid OR for eight years and af­ter part­ner­ing with the car­dio­vas­cu­lar sur­geons was able to get Abing­ton Me­mo­rial to make the in­vest­ment.

He has used the new OR, named for the late V. Paul Ad­donizio, pre­vi­ous chief of car­dio­vas­cu­lar surgery at AMH, “a lot” since it was com­pleted in Oc­to­ber. “A lot of higher com­plex­ity pro­ce­dures are planned for that room,” he said.

Aneurisms in ar­ter­ies that lead to kid­neys or other vi­tal or­gans re­quire spe­cial­ized stent sys­tems, Sul­li­van said, and the avail­abil­ity of the hy­brid OR “will pro­pel us to the next level, to take on more com­plex cases.”

One ex­am­ple is a new tech­nique, which can be done in place of a tra­di­tional valve re­place­ment, called tran­scatheter aor­tic valve re­place­ment, in which en­try is made through the groin and a valve is de­ployed on a stent, Gar­rido said.

“We are in the late stages of bring­ing that here to Abing­ton Me­mo­rial,” the Jenk­in­town res­i­dent said. “You need to have a hy­brid OR … the proper train­ing is next.

“To­day you need to be able to have a broader reper­toire for vas­cu­lar and car­diac treat­ments.”

“It’s a big com­mit­ment,” Sul­li­van said, not­ing the only other hy­brid OR in the im­me­di­ate area is at the Hospi­tal of the Univer­sity of Penn­syl­va­nia.

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