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. 2023 Sep;165(9):2343-2358.
doi: 10.1007/s00701-023-05756-7. Epub 2023 Aug 16.

The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review

Maria Gharios #  1 , Victor Gabriel El-Hajj #  2   3 , Henrik Frisk #  1 , Marcus Ohlsson  1   4 , Artur Omar  5 , Erik Edström  1 , Adrian Elmi-Terander  1   6
Affiliations

The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review

Maria Gharios et al. Acta Neurochir (Wien). 2023 Sep.

Abstract

Background: Hybrid operating rooms (hybrid-ORs) combine the functionalities of a conventional surgical theater with the advanced imaging technologies of a radiological suite. Hybrid-ORs are usually equipped with CBCT devices providing both 2D and 3D imaging capability that can be used for both interventional radiology and image guided surgical applications. Across all fields of surgery, the use of hybrid-ORs is gaining in traction, and neurosurgery is no exception. We hence aimed to comprehensively review the use of hybrid-ORs, the associated advantages, and disadvantages specific to the field of neurosurgery.

Materials and methods: Electronic databases were searched for all studies on hybrid-ORs from inception to May 2022. Findings of matching studies were pooled to strengthen the current body of evidence.

Results: Seventy-four studies were included in this review. Hybrid-ORs were mainly used in endovascular surgery (n = 41) and spine surgery (n = 33). Navigation systems were the most common additional technology employed along with the CBCT systems in the hybrid-ORs. Reported advantages of hybrid-ORs included immediate assessment of outcomes, reduced surgical revision rate, and the ability to perform combined open and endovascular procedures, among others. Concerns about increased radiation exposure and procedural time were some of the limitations mentioned.

Conclusion: In the field of neurosurgery, the use of hybrid-ORs for different applications is increasing. Hybrid-ORs provide preprocedure, intraprocedure, and end-of-procedure imaging capabilities, thereby increasing surgical precision, and reducing the need for postoperative imaging and correction surgeries. Despite these advantages, radiation exposure to patient and staff is an important concern.

Keywords: CBCT; Hybrid operating rooms; Neurointerventional procedures; Neurosurgery; Spine; Surgery.

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Conflict of interest statement

The authors declare no competing interests.

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