'Hybrid' OR Lets Surgeons Work Simultaneously to Restore Use of Arms for Utah Mom

'Hybrid' OR Lets Surgeons Work Simultaneously to Restore Use of Arms for Utah Mom

Aug 10, 2010 3:58 PM

SALT LAKE CITY—Marty Cranfill-Morton’s arms were so weak from constricted blood flow, she could not hold her 2-year-old son, let alone perform the myriad other tasks of daily life.

To fix this, two surgical teams would need to simultaneously inflate two angioplasty balloons in a graft in her upper aorta so they could place stents to increase the amount of blood to her subclavian arteries, the primary blood suppliers for the arms. But to do that, surgeons needed real-time, high-resolution images while they guided catheters containing the balloons from two different access points to the upper aorta – precisely what University of Utah Hospital’s new hybrid operating room (OR) is designed to provide.
 
“We would have had a very difficult time doing that procedure before we had the hybrid OR,” says Larry W. Kraiss, M.D., professor and chief of vascular surgery at University Hospital and the U School of Medicine and one of the surgeons who placed the stents in Cranfill-Morton’s aorta. “This operating room provides exactly what we need for that type of procedure (Cranfill-Morton’s) as well as other procedures and operations on arteries, the heart, aortic aneurysms, and traumas.”

The hybrid OR, which was constructed as part of a larger renovation of the hospital’s operating rooms, opened this spring. What sets this OR apart from others is a $1.8 million high-resolution, mobile Siemens imaging machine – called the Robot – that’s located in the operating room and provides very high quality images of blood vessels, arteries, and the heart that can be viewed in real-time to guide physicians and surgeons while they do procedures.  Whether it’s an angiogram, CT scan or conventional X-ray, vascular and cardiothoracic surgeons, cardiologists, and interventional radiologists have access to nearly any type of image they need for a procedure, without having to first send a patient to a separate imaging suite, which is more efficient and safer for patients.

“This new facility combines state-of-the-art surgical technology with state-of-the-art imaging in a single location,” Kraiss says.  “In the past, for example, a patient who had arterial blockages in the abdomen or legs would have an image taken in radiology and then go to one operating room for treatment.”  “Otherwise the surgeon would have to compromise the surgical options in order to get the best imaging or compromise the imaging to get the best surgical options. With the hybrid OR, that’s no longer necessary. It combines procedures and makes things more efficient; the patient gets one procedure instead of two without any compromise.”

The computer-controlled Robot doesn’t resemble the science fiction kind. It looks more like the letter “C,” a shape that allows it to take images from just about any angle and not interfere with a procedure. When an image is needed, the Robot is guided by computer to a precise spot at the operating table. Once a physician gets the image(s), the Robot is guided away from the table and sits unobtrusively in a corner until called upon once again.

That was a key advantage for Cranfill-Morton, who has Takayasu’s arteritis, a rare blood vessel disease that has inflamed her aorta and its main branches, restricting blood flow to her arms. A 2006 operation performed in Cleveland, in which she received an arterial graft to bypass blockages at the top of her aorta, increased the blood flow to her subclavian arteries. But in the past year scarring in the graft had impeded the blood flow again, with Cranfill-Morton’s arms becoming progressively more ischemic and weak.
 
The procedure was performed using general anesthesia, another aspect made simple by the spacious hybrid OR.  To place the stents and improve the blood supply to her arms, surgeons needed to inflate the balloons in the aortic graft at the same time – this would prevent either balloon from causing a bulge in the graft while being inflated. Once the balloons were in place, the stents could be inserted into the graft. The hybrid OR allowed Kraiss along with fellow vascular surgeon Mark Sarfati M.D., associate professor of surgery, to not only diagnose Cranfill-Morton’s problem but also provided immediate surgical capabilities in case a chest operation was necessary should the angioplasty fail or rupture the graft. 

Cranfill-Morton underwent the procedure in late May and said she’s regained much of the strength back in her arms. “The surgery really helped,” she said.

Takayasu’s arteritis is so rare that until recently Cranfill-Morton had to see a specialist at the Cleveland Clinic to monitor and treat her. But that specialist, Curry L. Koening, M.D., has joined University of Utah Health Care and the U of U medical school faculty as an assistant professor of internal medicine, meaning Cranfill-Morton no longer has to leave the state for the specialized care related to her disease.
That’s a huge relief. “It’s so much easier on me and my family,” she says.

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