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One Stop Digital Surgery

A single room that integrates a powerful array of high tech surgical tools shows the future of the computerized O.R.
June 25, 2004

At home it may be pleasant having different rooms for different occasions, but in hospitals it can be a confusing and sometimes inefficient game of musical gurneys. This spring, Providence St. Vincent (PSV) Medical Center in Portland, OR, began conducting major heart, chest, and abdominal surgeries in its $3.5 million digital surgical suite. Twice the size of most operating rooms, the facility incorporates an array of high-end technologies in a unique, single-room arrangement that is expected to increase operation efficacy and even lower hospital costs.

Hospitals around the country boast new technologies, such as the Da Vinci robotic surgical unit from Intuitive Surgical. But in the PSV facility, this million-dollar unit is just one piece of equipment alongside an assortment of high tech tools. There are, for example, voice-activation-operated cameras for peering into the circulatory system, as well as high-definition television systems for imaging during video-endoscopywith not one but four screens available to the surgeon.

The suite is also rigged with a ceiling-mounted fluoroscopy machine for angiography; the machine looks like a six-foot-tall hearing aid. For procedures like inserting stents to open vessels, using grafts to strengthen ballooning arteries, or performing robotic-assisted operations, surgeons in the suite can use 3-D images of the heart produced by fluoroscopy to help them assess the quality of the operationon the spot, instead of moving the anesthetized patient to another room, or perhaps even waiting until an angiography suite is available. Radiologists have been using fluoroscopy to observe inside vessels for years, of course. What’s new at the PSV center, says Wright Pinson, chief medical officer at Vanderbilt University Medical Center, is that surgeons are taking this technique into the operating room.

Hospitals now juggling patients between operating rooms, catheter labs, and endoscopy suites could look to the PSV room as a model. The table, for instance, can either be fixed for surgery or adjusted for imaging procedures that require the patient be positioned at multiple angles. This seems like a small innovation, but without the dual-purpose table, it would be impossible for this single space to serve the varied purposes of surgery, angiography, and endoscopy.

In writing about cutting-edge endoscopy suites, or “endosuites,” Yale School of Medicine assistant professor Steven Palter explains the advantages of integrating operating controls, which is another key component of the PSV facility: The surgeon operating the system can control every aspect of the operating room and its interface with the hospital and the physician’s office, he says. Integrated controls can include anything from adjusting lighting, cameras, and photo printers, to teleconferencing, patient records, and suction devices. The goals behind all these new control systems, according to Palter: shortening the procedure time, improving ergonomics, and freeing nurses for other tasks. The PSV suite not only provides this integration when it is used as an endosuite, but also during angiography or general surgery procedures.

Standing in clogs and speaking too fast for the small audience of elderly philanthropists who have come for a tour of the new facility, cardiothoracic surgeon (and engineer) Michael Savitt is just as excited about how the suite can be pared down to a bare-bones operating room as he is about its high-tech tools and robotics. During a demonstration, the spidery black arms of the Da Vinci robotic surgical system delicately manipulate a stitch on a pretend piece of flesh inside a plastic ribcage on the operating table. Another surgeon jokes that it looks like a great device for tying fly-fishing flies.

The old model for operating rooms was that hospitals would build anew or retrofit old rooms to accommodate new technologies. But Savitt, who is the architect of the PSV room, has designed the suite to ensure that it will be suitable for various types of surgeries and yet not dependant on a technology that may become outdated in 5 or 25 years.

Each of the technologies in which PSV has chosen to invest would, on its own, represent a major investment at any hospital. What Savitt has done is package many of them into a space that enables this single operating room to host procedures, or combinations of procedures, that previously would have been scattered throughout the hospital. And energy not spent shuttling patients around the facility can go toward healing them.

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