[The hybrid operating room: a cross between a catheterisation room and an operating room]. / De hybride operatiekamer: een kruising tussen een katheterisatiekamer en een operatiekamer.

A hybrid operating room is a space that meets all the stringent requirements of an operating room harbouring the facilities of an interventional radiology or cardiology room. This technical innovation facilitates complex endovascular and hybrid operations in a sterile environment. The high-end imaging technique with the ability to perform three-dimensional reconstructions will lead to improved quality of endovascular operations. Moreover, this technique enables physicians to explore and extend the boundaries not only of cardiovascular but also of navigated minimally invasive surgical techniques.

[Diagnostic image. A man with haematemesis after stent repair of the abdominal aorta]. / Een man met haematemesis na buisreconstructie van de abdominale aorta.

An 86-year-old man suffered acute necrotizing oesophagitis as a complication of elective repair of an abdominal aortic aneurysm.

Harmonic long shears further reduce operation time in transanal endoscopic microsurgery.

BACKGROUND: Previous research indicates that application of 5-mm harmonic shears rather than diathermia significantly reduces operation time in transanal endoscopic microsurgery (TEM). Frequently, however, additional instruments were required to complete resection. We investigated whether the new 5-mm harmonic long shears (H-LS) are better equipped for TEM compared with regular harmonic shears (HS). METHODS: Between 2001 and 2006, 162 tumors (117 adenomas, 42 carcinomas, and 3 other tumors; mean distance 6.6 cm, mean area 40 cm(2)) were excised in 161 patients (82 men, 79 women; mean age 66 years). RESULTS: Eighty-eight resections were performed with HS and 74 with H-LS. Tumor and patient characteristics were similar except for specimen area. Tumors resected by H-LS were on average smaller than those resected by HS (34.4 versus 44.1 cm(2); Mann-Whitney U-test: p = 0.027). Mean operation time was 48 min and proportional to area in both groups (univariate analysis of variance p < 0.001). Mean operation time was 54 min using HS and 41 min using H-LS (t-test: p < 0.001). After correction for area, operation time for H-LS was reduced by 14% compared with HS (t-test: p < 0.001). H-LS is singly capable of completing resection in 88% compared with 26% for HS (Mann-Whitney U-test: p < 0.001). Mean blood loss was 16 cc for HS and 3 cc for H-LS (p < 0.001). Morbidity (11%) and mortality (0.6%) were not different between the two groups (Fisher's exact test). CONCLUSION: Performing transanal endoscopic microsurgery with 5-mm harmonic long shears reduces operation time compared with regular shears, and completing resection seldom requires other instruments.