Guideline Implementation: Minimally Invasive Surgery, Part 2—Hybrid ORs

Abstract

Performing both surgical and imaging procedures in a hybrid OR can increase efficiency by reducing the number of patient transfers between departments and the number of patient hand overs between personnel. A hybrid OR is, however, a complex environment that requires integrating the knowledge and skills of personnel from multiple disciplines to create a successful workflow. When magnetic resonance imaging (MRI) equipment is installed in the hybrid OR, additional precautions are required to help ensure the environment is safe for patients and personnel. AORN's updated "Guideline for minimally invasive surgery" provides guidance for personnel designing and working in hybrid ORs and MRI hybrid ORs. This article focuses on key points of the guideline that address hybrid OR configuration, hybrid OR staffing, and mitigating risks associated with intraoperative MRI. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review

“…The included manuscripts mainly consisted of informal (non-systematic) reviews (n=10) [2][3][4][5][6][25][26][27][28][29], institutional experiences (n=10) [30][31][32][33][34][35][36][37][38][39], and case series/retrospective studies (n=12) [40][41][42][43][44][45][46][47][48][49][50][51], with only a few prospective studies (n=4) [52][53][54][55]. We also included 11 references that were published only in abstract form [56][57][58][59][60][61] or case report format [62][63][64][65][66].…”

“…Stratified by imaging modality, the vast majority of manuscripts focused on iMRI alone (n=44) or on iMRI combined with angiography (n=3) [30][31][32]. The most commonly used operating room setup involved a mobile iMRI machine, but six manuscripts specifically discussed transfer of the anesthetized patient into a fixed MRI scanner [32,33,36,40,47,53].…”

“…Typical exclusion criteria cited were patients with contraindications to MRI scanning (such as some implants and ferromagnetic foreign bodies), patients with significant coronary artery disease (due to limited ECG ischemia monitoring), small infants (due to difficulties resulting from dead space and temperature control), and obese patients (due to difficulty with positioning and inability to fit into the scanner fully draped) [2, 4, 5, 26, 27, 29, 31, 32, 34, 35, 38, 39, 44-46, 49, 50, 55, 60, 63, 66]. The prolonged preparation time and case duration related to the complex setup and extensive safety measures was frequently mentioned [6,25,28,31,32,34,35,39,42,44,50,51,55,57,59,63,65]. A few authors specifically commented on the unfamiliarity of the iMRI suite or distractions, including the noise burden [3,6,26,29,33,34,38,39,45,46,55,61,63,64,65].…”

Guideline Implementation: Minimally Invasive Surgery, Part 1

“…The scope of the guideline is broad; therefore, this article elaborates on key takeaways from the guideline in reference to minimally invasive and robotic‐assisted procedures. Guidance for procedures in hybrid ORs and hybrid ORs with magnetic resonance imaging, also covered in the MIS guideline, will be discussed in a subsequent article 5 . Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.…”

“…Guidance for procedures in hybrid ORs and hybrid ORs with magnetic resonance imaging, also covered in the MIS guideline, will be discussed in a subsequent article. 5 Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.…”