Skorup said they see the most variability in construction costs. Some facilities might build the room from scratch, while others could consolidate two ORs into one big room.

Historically, ORs are big spaces, taking up roughly 800 square feet of space. But hybrid ORs require at least 1000 square feet — almost double in size. The rooms are also more complex, with up to 100 technologies required, including large mounted C-arms, and a more crowded team of clinicians.


Top vendors

The report highlights one vendor who got a jump on the market. Skorup said Siemens Healthcare's Artis zee imaging system gained traction because of the C-arm's ability to rest in the corner of the OR when it's not in use.

"The ability to move it and being able to park it out of the way has space implications," said Skorup.

The Artis zee was also marketed as having robotic capabilities related to the axis of articulation for the C-arm. However, this system runs at a higher price point in the market. Skorup said GE Healthcare and Philips Healthcare also offer comparable systems, and Toshiba has been competitive in more niche markets.

But it's not just floor space that needs to be taken into consideration. Skorup said ceiling requirements are also a serious part of the planning process.

"It becomes very busy real estate: you have surgical booms, lights, air flow considerations that can't be impeded. That can be complex to design," he said.

Safety concerns

While an enormous planning effort goes into constructing hybrid ORs, safety concerns are also paramount, according to the report. Skorup highlights radiation safety for the patient, but particularly the staff who are exposed day after day.

"We are talking about training surgical people to do dose safety," said Skorup. This might not be as ingrained as it would be for radiologists who began their training with safety in mind.

Proper training with such a large team is also a priority for patient safety and maximizing pricey OR time, according to Skorup. He recommends having a licensed professional run the imaging system so they can help pull images for surgeons when they need them.

Room for growth

While the report focused on endovascular hybrid ORs, Skorup said it's not limited to this area.

"There's an appetite for potential to do a combination downstream of both endovascular and maybe laparoscopic procedures, and of course the need to transfer from endovascular to open procedures if things are not going right," he said.

Right now, he said he feels strongly about getting decision-makers to understand what they need — whether it be a hybrid OR or a hybrid cath lab that's OR ready.

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