Hybrid OR Equipment & Systems

Setting the Stage: Getinge Shares Expertise in Hybrid OR Design and Installation

Thomas Schneider, Vice President Global Product Management Surgical Workplaces, and Thomas Reichenbach, Director Global Product Management Hybrid OR Solutions, Getinge

Thomas Schneider, Vice President Global Product Management Surgical Workplaces, and Thomas Reichenbach, Director Global Product Management Hybrid OR Solutions, Getinge

Could you describe Getinge’s Experience Centers?

Thomas Schneider, Vice President Global Product Management Surgical Workplaces: Getinge actually has several Experience Centers located around the world. The largest is based in Rastatt, Germany. Rastatt is very close to the French border, about 150 kilometers south of Frankfurt and 100 kilometers west from Stuttgart. This Experience Center is a meeting point for customer visits, training such as patient positioning workshops, and various Getinge events connecting people.

Thomas Reichenbach, Director Global Product Management Hybrid OR Solutions: The Rastatt Experience Center has two complete hybrid operating theaters, one that is brand new, featuring the Azurion 7 C20 with FlexArm imaging system from Philips, and one hybrid operating theater opened together with Siemens Healthineers, featuring their ARTIS pheno system. In addition, there are three fully equipped operating room setups in order to show our customers the complete solution Getinge offers. On top of that is a central sterile supply department (CSSD) setup with washing, disinfection, sterilization, low-temperature sterilization, and a tracking system T-DOC to track sterile goods.

Thomas Schneider: Other Experience Centers include one based in Tokyo, Japan, which contains two hybrid OR rooms, one with a Philips system, and one with a GE Healthcare system. A third Experience Center is based in Singapore, and includes a hybrid OR room with Siemens imaging equipment mock-up; it is a fully equipped theater and is an all-public facility. Furthermore, we have a fully equipped showroom with Philips in their APAC Center. We also have an Experience Center in the United States, in Wayne, New Jersey. Getinge is also represented in the Philips facilities in Netherlands, where we have a hybrid OR equipped with the Maquet Magnus operating table, as well as hybrid operating theaters installed at the Siemens Healthineers facilities in Germany and the GE Healthcare facilities in France, fully equipped with our equipment.

What are typical dilemmas that Getinge helps to solve?

Thomas Reichenbach: When people come to us, they are primarily concerned with how to set up hybrid ORs. Customers know well how to set up individual rooms for various disciplines, but hybrid rooms require attention to a multitude of detailed concerns, because a hybrid OR is not used very often for a single discipline. Smaller hospitals, for example, will usually have hybrid ORs with the goal of filling the room with a wide array of procedures. Customers are very interested in, first of all, viewing our table, which is slightly different from a typical imaging table in terms of workflow and patient positioning. People want to see what options exist to combine surgery and imaging in terms of positioning patients correctly while still providing proper imaging access. Second, we can demonstrate how to set up the ceiling and the walls in order to facilitate smooth workflow. That means there should be no equipment installed that is not within the necessary workflow and yet enough equipment installed in order to accommodate all the different disciplines. For example, anesthesia requires several connection points. Other areas of focus include ergonomics, monitor displays, air conditioning, and laminar flows — typically, all these topics will arise, depending on the customer. Getinge shares its experience in designing a room in the proper way.

Thomas Schneider: Getinge can offer a complete room, including prefabricated modular rooms, ceiling systems with laminar airflow, and basically all the necessary equipment required for a hybrid operating theater or standard operating theater, including software solutions for workflow support. Imaging equipment is added by our partners. It is certainly possible to buy equipment from various parties, but it then becomes extremely complex to set up such a project within a tight timeline and with all the different interfaces. What people see in our Experience Center is a complete solution from two partners: Getinge and one of our imaging partners. Getinge has now done more than 1400 installations worldwide. We are by far the company with the largest experience in the implementation of operating theaters, and I believe for many customers that is a major benefit, because we have people who have been working in this field for years, with a great deal of experience in finding solutions for complex environments. 

Thomas Schneider: People may come into the Experience Center and start out by asking, “What size does a hybrid operating theater need to be in order to allow us to work in a good environment?” We begin from that very basic level and eventually may arrive at a point where, based on the customer’s given location, Getinge does the complete planning of the room. We have had to set up a very efficient workflow in combination with unchanging OR theaters, for example. However, it could also be that by the end of the day, based on what we learn, we tell the customer that they will need to go for too many compromises and should not move forward. Find another space; find more space. Success starts with the planning. If you do the right planning, you will later have a very efficient working environment. If the planning goes wrong, it is remains a nuisance for years. This consultation phase is extremely important and that is where Getinge has a great deal of experience. It is a real consultancy approach. I have always felt that converting existing space into a hybrid OR typically requires two ORs, size-wise. Definitely more space will be needed to accommodate all the equipment and workflows. It is easier to influence planning, if we get involved in the very early stages of a new facility. We can consider how a control room is positioned, how to best position the imaging system and the table in relation to each other, and how to shape the ceiling equipment, lights, lead shields, laminar air flow, and so on.

Thomas Reichenbach: In addition to the workflow and the architecture, we can also discuss the room’s medical application. One of our colleagues, Mohamed Elghawaby, was recently transferred from the Middle East to the Rastatt Center of Excellence for Hybrid Theaters. He is a surgeon and thus we can support our customers not only with medical expertise, but also share knowledge on practical application: how do you position the patient? What is the best access? Customers are asking, more and more, for this type of support from us.

Thomas Schneider: There are various roles that need to be involved as a room comes together, because a hybrid OR is an interdisciplinary approach. Our primary contacts are surgeons, as we come more from the surgical world, but as imaging gets involved, we also talk with interventional radiologists and cardiologists. We need to involve anesthesiologists, biomedical engineers, head nurses, and purchase departments, as well as the CEO of the hospital, of course. It really depends on our market as to how we approach and work with customers. 

Thomas Reichenbach: I believe many hospitals, especially in the U.S., are also using hybrid operating theaters for marketing reasons. First of all, to attract surgeons with a very good reputation, who might only be willing to change to a different hospital if they are offered the ability to work in a hybrid OR. It is also used to attract patients. The rooms are significant investments, and it may be three million USD or more for a complete room. It automatically triggers the involvement of different levels of administration, all the way up to the CFO and CEO.

Thomas Schneider: It is not only about working with customers, but also about involving our valued imaging partners. Getinge works with GE Healthcare, Canon Medical Systems, Siemens Healthineers, and Philips. We need our imaging partners to be involved in these discussions. We see a clear trend of customers looking into multimodality setups. That means not only having one imaging system connected to a surgical table, but it can even be three different modalities: MRI, CT, and angiography being connected to or accessible from the same table in order to provide interoperative diagnosis and treatment support.

Thomas Reichenbach: The patient stays on the same platform for all types of imaging, which is a major benefit for the patient, but also for the staff. It also allows for quicker treatment, which can mean safer treatment.

Where do you see the hybrid OR headed?

Thomas Schneider: Transcatheter aortic valve implantation (TAVI) and endovascular procedures are already, at least in mature markets, well established. That is why I think multimodality imaging will be key, because we of course also search with our imaging partners for new application areas. Procedures typically done as open surgery are transforming into minimally invasive surgical procedures. One example is cancer treatment. Embolization means clinicians can cut off a tumor from blood supply before resection or we can even destroy the tumor with radiation, or by applying heat or cold. Here, also, technologies facilitating image-guided needle placement have been, observed to have the ability to help destroy a tumor with ablation. The spine is another area that is rapidly developing, going from open to minimally invasive procedures. These are a few examples of how we are becoming surgically more minimally invasive and incorporating image-guided support.

It sounds like major centers might need multiple hybrid rooms.

Thomas Reichenbach: We equipped one hospital in Turkey with three ORs: one with access to a sliding-gantry CT, the second one with access to angio, CT, and MRI, and the third with access to MRI. Large university hospitals and their feeding centers may go for more. You also have an institute in Strasbourg, France, with a multimodality setup integrated with angio, MRI, and CT. Several multimodality imaging sites have already been built; Getinge handled, for example, sites in the U.S., Japan, China, and Taiwan. These type of hybrid ORs are typically in hospitals that have more than one room connected to this expensive imaging equipment. Especially for MR, if you can connect more rooms to one system, then, of course, it is more cost-effective and efficient. Getinge also can offer its experience as hospitals look into how to best utilize MRI. For example, when MRI is not being used for interoperative imaging, we can share how it can also be utilized for outpatient diagnostics. There are hospitals with imaging located between two ORs, so that MR and CT systems are accessible from both rooms, but also accessible for patients for normal diagnostic purposes, in case the imaging (a serious investment) is not needed intraoperatively.

Hospitals may have a new issue on their hands as various disciplines plead for time in these rooms.

Thomas Schneider: We see that there is a rising interest from different disciplines just in the past four years. Of course, cardiology has been involved for quite some time. Neurosurgery is coming up, and also spine, but now, it is mainly two different disciplines, cardiac and vascular treatment. Oncology is showing more and more interest in hybrid ORs, because if they can treat the patient in a minimally invasive manner, it shortens recovery times. An initial image-guided treatment also avoids having to do surgery twice, allowing you to avoid having the same patient on the table several times just for corrective actions. Also under consideration is time spent under anesthesia, and opening and closing the patient again, concerns that play a major role when physicians determine how to obtain the best possible outcome for the patient.

Any final thoughts?

Thomas Schneider: Our newest Experience Center in Rastatt can be always visited by interested customers or anyone who is interested in learning more. We are not just looking to receive customers for discussions about how to set up a room; we also hope to offer workshops on how to best utilize a hybrid OR. Education on room use is typically difficult to accomplish in a hospital, because of sterile conditions — bringing several people in might get critical and blocking the room off for education might get expensive. The facilities at our Experience Centers allow our customers to explore a real OR that enables efficient workflows, because it is embedded in an environment meant to simulate a working room. Customers can also benefit from learning in a similar environment that is outside a critical environment.

Getinge Opens New Hybrid OR in One of Its Experience Centers

Getinge recently inaugurated a brand new hybrid operating room (OR) in its Experience Center in the German city of Rastatt. This new room with Getinge OR products combined with Philips’ imaging solutions will help prepare even more hospitals for the future.

When it comes to driving the future of the hybrid OR, Getinge has been a pioneer for the last twenty years, combining a state-of the-art OR with imaging systems such as angiography systems, computed tomography scanners (CT), or magnetic resonance imaging scanners (MRI).

Getinge has, throughout the years, teamed up with several imaging partners to provide a complete solution and the best possible working environment for clinicians, where they can diagnose and treat patients at the very same time.

“We are proud to have this hybrid OR in our Experience Center in Rastatt together with Philips. Here, we can welcome both Getinge and Philips customers to have a look and feel at some of the latest technologies within the hybrid OR,” says Thomas Reichenbach, Director Global Product Management Hybrid OR Solutions at Getinge.

The October 2019 inauguration brought visitors from all over the world and the doors are always open to all Getinge Experience Centers, where visitors can learn more about the Getinge products in a real-life environment.