Innovations within the hybrid operating rooms (HOR) are developing at a rapid rate, the latest blockbuster innovations include: augmented reality software systems, 3D medial printing and robotics systems; all aiming to transform pre-surgical planning.

Change is a traditionally slow and time-consuming process, however, as technology continues to develop at an exponential rate, many hospitals are eagerly adopting new technologies in order to differentiate their patient services. Innovations within the hybrid operating rooms (HOR) are developing at a rapid rate, the latest blockbuster innovations include: augmented reality software systems, 3D medial printing and robotics systems; all aiming to transform pre-surgical planning.

Underlying drivers

The United Nations predicts the world’s population will reach 9.7 billion by 2050; an expected rise of 2 billion from the current 7.7 billion. While, the rate of growth has slowed, the population demographic will continue to shift towards an aged population, further increasing demand for healthcare worldwide. The financial burden on current healthcare infrastructures have already emerged in developed markets. Countries in the western hemisphere are also not immune to such pressures with many planning to restructure current healthcare systems to meet future demands. France has been going through a major reorganization (“My Health 2020” initiative) during recent years and the United Kingdom (UK) continues to address the many problems of its National Health Service (NHS) with progress continuing to be plagued by the ever-looming BREXIT.

As the world population continues to age it is inevitable the number of surgical procedures will rise. Chronic diseases will further compound the number of unavoidable surgeries, such as orthopedic surgeries as a result of increased rates of falls and accidents amongst the geriatric population. Between April 2009 and March 2014, just under 40 million surgical patient episodes were recorded in the UK, an average of 7.9 million per year. An extrapolation will highlight the need to improve and streamline surgical procedures.

Technological developments with HOR

Hybrid operating rooms (A fixed angiographic C-arm X-ray system that is installed in a surgical or interventional suite and is used for imaging during open or minimally-invasive procedures in surgery) are aiding healthcare providers in order to make surgery less traumatic for patients and minimize incisions. Hybrid operating rooms have seen some major developments in recent years which include:

  • Robotics systems – The platform will enhance interventional procedures performed for patients and offers a better working environment by assisting medical teams in increasing precision and accuracy of surgeries.
  • Artificial intelligence – The software systems optimizes procedure selection & preparation while also saving time and radiation dose.
  • 3D medial printing – 3D printing in medical imaging has the potential to facilitate decision-making in cardiovascular care; it can be used to communicate with patients, training staff, or used for planning interventional procedures.
  • Augmented reality systems – The technology will enable operators to see 3D images of anatomy in display while they are looking at the patient thereby enabling access to precise tumor treatment in the 3D space.

Minimally-invasive surgeries

Operating rooms equipped with advanced medical imaging systems are enabling minimally-invasive surgeries to increase in incidence worldwide. There are inherent benefits to minimally invasive treatments (figure 1). Being minimally invasive means that patients do not need to spend time in high dependency care thereby reducing length of time spent in hospital, which in turn produces significant cost savings. Many interventional radiology (IR) and interventional cardiology (IC) procedures have revolutionized the clinical management of certain diseases.

According to the American Heart Association, Cardiovascular disease (CVD) is one of the underlying causes of death in the United States, in 2016 CVD accounted for 840,678 deaths in the United States alone (approximately 1 in every 3 deaths). CVD and stroke accounted for 14% of total health expenditures between 2014 and 2015. Looking ahead, total direct medical costs of CVD are projected to increase to $749 billion in 2035.

Aortic stenosis is one of the most common heart valve diseases; prior to minimally invasive treatment options traditional surgeons routinely used surgical aortic valve replacement/implantation (SAVR, or SAVI), however transcatheter aortic valve replacement/implantation (TAVR, or TAVI) is a more recent procedure used by interventional professionals and has minimalized the risk to patients, fast becoming the gold standard treatment.

Innovative manufacturers can further improve patient outcomes in procedures such as TAVI by augmented reality systems (AR). Augmented reality systems within HOR’s are fast becoming an increasingly discussed topic; newer generations of the innovative technology are already on the horizon to aid procedural navigation.

The technology will enable operators to see 3D images of anatomy in display, while they are looking at the patient much like a science fiction movie. Philips Healthcare has already showed conceptual work-in-progress of this technology with capabilities to manipulate 3D images with hand movements in the air. In the future, interventional professionals will have the luxury to use the technology as part of surgical planning to visualize sites of incision thereby increasing accuracy.

Researchers from the Interventional Radiology Research and Simulation Lab (IR-TRSL) have been using the Philips Healthcare developed technology to overlays images from CT and MRI scans (of the simulated patient). The overlaying process enables researchers to display and track a digital image of their needle as it is advances through a simulated patient. Through further collaborative approaches, the technology can be used as part of treatments in spine surgery (e.g. the placement of sacral nerve stimulators) and in localization and removal of lung tumors.

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Figure 1 – The advantages of minimally invasive procedures

Expansion of applications

The volume and the clinical diversity of interventional procedures are the major contributing factors of hybrid operating rooms as interventional procedural volume continues to grow year on year. Interventional cardiologists are the most frequent users of HORs as cardiovascular disease is the number one cause of deaths globally (17.9 million people died from CVDs in 2016). The last few years have seen expansion in the types of surgeries performed (Figure 2), this includes:

  • Cardiac and vascular surgery
  • Ortho-trauma-spine surgery
  • Neurosurgery
  • Thoracic and abdominal surgery
  • And other surgeries

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                                                                                                                    Figure 2 - Hybrid operating room by percentage application split at a global level         

As interventional procedures continue to become more advanced and in turn complex, a wider variety of professionals are increasingly performing minimally invasive procedures. It is evident minimally invasive treatments ensure patients spend less time in hospitals, which in turn produces significant cost savings.

HORs and interventional procedures are costly, as the economic landscape of healthcare continues to evolve, it is essential for radiologists to understand the economic evaluation of treatments and procedures. In September 2019, the Society of Interventional Radiology (SIR) launched the “Vision to Heal, Together campaign”. It aims to strengthen partnerships with physicians to better inform patients about minimally invasive procedures as treatment options.

IHS Markit will continue to follow the forecast growth of the market for hybrid operating rooms by usage and other major trends in the interventional X-ray market as part of the as part of our coverage of the X-ray Intelligence service. The service includes syndicated reports on Mammography X-ray systems, Interventional X-ray systems and General Radiography and Fluoroscopy. For more information, please contact Sharjeel Ahmad at