[Hybrid operating rooms: only for advanced endovascular procedures?]

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Engineering

Context:

• The advancement of endovascular techniques has spurred the development of the hybrid operating room (OR), integrating surgical sterility with advanced imaging.
• Existing guidelines in some regions mandate hybrid ORs for standard endovascular procedures, yet Germany lacks formal recommendations.
• This necessitates a framework to guide infrastructure requirements for endovascular interventions.

Purpose:

• To propose a classification system for endovascular procedures based on complexity and imaging needs.
• To define which procedures necessitate the specialized environment of an angio-hybrid OR.
• To address the absence of formal guidelines in Germany regarding hybrid OR use in endovascular surgery.

Summary:

• Endovascular procedures are categorized into four levels based on complexity and fluoroscopy requirements.
• Level 1 (standard EVAR, TEVAR) and Level 2 (simple fenestrated stent-grafting) can be performed outside a hybrid OR.
• Level 3 (complex fenestrated) and Level 4 (branched stent-grafting for TAAA) procedures are recommended to be conducted exclusively within a hybrid OR.

Impact:

• Provides a rational basis for determining hybrid OR necessity in endovascular surgery.
• Aims to standardize infrastructure requirements, potentially improving patient safety and outcomes.
• Offers guidance for healthcare policy and professional societies in the absence of formal regulations.