AW: AW: [HSF] Hybrid operating room

[Ani Anyanwu]

Dr Zhou
 
Thank you for your detailed explanation. I agree that until we know which direction these therapies are going it is better to develop capability to handle them. I know though last time I spoke to a texas surgeon and they had done 22 stent grafts in a years so the room was being grossly underutilized. The truth is that in the present time there is little demand for these hybrid vascular procedures, so many hospitals use the hybrid room as an extension of the vascular radiology suite (at an extreme cost as OR time and personnel is more pricey) or as a general OR (also at an extreme cost because of size and facilities of these rooms). That may change in future.
 
In wanting a hybrid OR with robotic capability, am I correct in assuming your team's intention or practice is to perform both the MIDCAB and PCI at one setting?
 
Also is it your feeling that when planning OR development, all centers should look to having such capability to perform robotic assisted MIDCAB with PCI (we no longer do robotic MIDCAB at my center)?
 
Thanks
 
Ani
 



> From: zzhoumd at pol.net> To: OpenHeart-L at lists.hsforum.com> Subject: Re: AW: AW: [HSF] Hybrid operating room> Date: Sun, 4 Nov 2007 23:04:51 -0500> CC: > > Dear Ani, > > You raised a very good question. The hybrid operating room is mainly built for cardiovasucular procedures, i.e. vascular or cardiac surgery for stent graft. It is also necessary for endo valve and trans apical valve in the future. The rooms are usually bigger than existing room. If the equipments are not in the way of robotic instrument, we can use it for robotic cases as other rooms are too small for robot.> > The idea of hybrid (some call intergrated) coronary revasculization is based on the assumption that DES (drug eluting stent) is comparable to vein graft, but not as good as LIMA. The data so far seems support that idea for type A or B lesions. However, LIMA is the only graft has been shown with survival benefit, not DES. > > Recently, our cardiologists are interested in doing hybrid procedures. Surgeons place the LIMA to LAD, then cardiologists stent the RCA and/or Cx if the lesion is type A or B. with Robot assisted IMA taken down, the surgery incision is only 5-6 cm. I can take down LIMA within one hour with Robot if the anatomy is favorable.> > I do not know what the future stands for this kind hybrid procedure. I have done about 10 cases with our cardiologists. So far, patients are doing very well. I do know Texas Heart has at least 3 hybrid operating rooms. University of Maryland has one. Vanderbelt has one now and they are building 5 more hybrid rooms. Our robot is so booked up, I can only get one day per week and I do need more time. Our urologists have wating list for about 3 months. Gyn and general surgery also use it for abdominal cases. > > I wish I could come to your dinner meeting so we can have a debat about hybrid or none hybrid. Like many other professional services, cardiac surgery is a service. We, as a surgeon, provide all the services for our customers, i.e. cardiologist, primary care physicians and patients. Many times, the decision is handed to us, not made by us. With so many of us around, if you do not like it, someone else will do it.> > I attach a picture of a case I did a few weeks ago. Patient has LIMA to LAD and Diag with a Y graft.> > Z Zhou> > 
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