Image-guided procedures in the hybrid operating room: A systematic scoping review

Abstract

Background The shift from open to minimally invasive procedures with growing complexity has increased the demand for advanced intraoperative medical technologies. The hybrid operating room (OR) combines the functionality of a standard OR with fixed advanced imaging systems to facilitate minimally invasive image-guided procedures. Objective This systematic scoping review provides an overview of the use of the hybrid OR over the years, and reports on the encountered advantages and challenges. Methods We conducted a systematic search in PubMed, Embase, Web of Science, and Cochrane library databases for studies that described procedures being performed with the aid of 3D imaging in the hybrid OR. Results The search identified 123 studies that described 44 distinct procedures, divided over nine clinical disciplines. The number of studies increased from two in 2010 to 15 in the first five months of 2020. Ninety-nine (80%) of the studies described how 3D imaging was performed in the hybrid OR; 95 (96%) used cone-beam CT; four (4%) used multi-detector CT. Advantages and challenges of the hybrid OR were described in 94 (76%) and 34 (35%) studies, respectively. The most frequently reported advantage of using a hybrid OR is the achievement of more accurate treatment results, whereas elongation of the procedure time is the most important challenge, followed by an increase in radiation dose. Conclusion In conclusion, the growing number of clinical disciplines that uses the hybrid OR shows its wide functionality. To optimize its use, future comparative studies should be conducted to investigate which procedures really benefit from being performed in the hybrid OR.

Added Value of Selective Intra-arterial Cone-Beam CT Angiography in the Management of Visceral Artery Aneurysms

“…In a recent scoping review, performing CBCT imaging in the hybrid OR provided intraoperative, cross-sectional, and 3D imaging of vasculature and implanted devices such as stents/stent grafts. 18 In addition to better spatial resolution and intra-arterial contrast opacification, CBCTA also enables integrated image fusion and overlay of 3D information such as vessel ostia on 2D fluoroscopy, for interventional guidance, contributing to radiation exposure reduction. 19 Newer generation hybrid ORs also showed better long-term clinical outcomes in complex endovascular aortic procedures as compared with mobile C-arms.…”

Hybrid operating room applications for precision hepatobiliary surgery: A narrative review

“…3 Gradually, it has been implemented in other surgical specializations such as vascular, neuro-, orthopedic, and trauma surgery. 2,4 Presently, many centers are equipped with these state-ofthe-art facilities. 5 The availability of on-site imaging in the surgical environment eliminates the need for patient transfers and facilitates immediate assessment of operative results.…”

The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review

“…Hence, both budget and space restrictions impact the installation and adoption of hybrid-ORs in modern surgical practice. Nonetheless, the past decade has witnessed an increase in the use of hybrid-ORs, in terms of both the number of procedures performed as well as the number of surgical specialties employing them [ 68 ]. In fact, hybrid-ORs are currently being used in cardiothoracic, vascular, orthopedic, otolaryngology/cervicofacial surgery, oral and maxillofacial surgeries, urology, as well as neurosurgery [ 68 ].…”

“…Nonetheless, the past decade has witnessed an increase in the use of hybrid-ORs, in terms of both the number of procedures performed as well as the number of surgical specialties employing them [ 68 ]. In fact, hybrid-ORs are currently being used in cardiothoracic, vascular, orthopedic, otolaryngology/cervicofacial surgery, oral and maxillofacial surgeries, urology, as well as neurosurgery [ 68 ]. According to a recent scoping review of the literature, most of the research on hybrid-ORs has been conducted within the field of thoracic surgery, reporting the performance of procedures such as tumor resection or ablation, lung biopsy, and image-guided video-assisted thoracoscopic surgery [ 68 ].…”

“…Based on the latest consensus definition, a hybrid-OR is a surgical room equipped with a coordinate-based imaging system such as CT, MRI, or CBCT, in combination with auxiliary imaging techniques such as fluorescence and ultrasound. In neurosurgery, cone-beam computed tomography (CBCT) has been the most commonly used intraoperative 3D imaging modality [ 68 ]. A CBCT system consists of an x-ray tube and image detector that rotates around the patient, capturing a series of (2D) projections using a cone-shaped x-ray beam.…”