1.　Clinical Application of Hybrid Operating Room for Neurosurgery

Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine
Yuichi Murayama, Toshihiro Ishibashi, Ichiro Yuki, Shougo Kaku
Hiroki Ohashi, Ryosuke Mori, Issei Kan, Kengo Nishimura, Satoshi Ikeuchi

Abstract
Recent advances in surgical and endovascular techniques have facilitated complex neurovascular treatment. However, some complex vascular diseases need combined surgical and endovascular technique. Newly designed robotic DSA system Artis zeego and biplane system were installed in Hybrid operating rooms (ORs). The system consists of a modified surgical OR table and carbon head clamp. In addition to conventional neuroendovascular procedures, the system was used as an intra-operative imaging tool for various neurosurgical procedures such as aneurysm clipping or spine instrumentation. More than 3000 neurosurgical procedures were successfully conducted in the Hybrid ORs. We describe our experience of modified Digital subtraction angiography (DSA) system in the Hybrid operation room (OR).
Newly designed robotic DSA system Artis zeego and biplane system were installed in Hybrid operating rooms (ORs). The system consists of a modified surgical OR table and carbon head clamp. In addition to conventional neuroendovascular procedures, the system was used as an intra-operative imaging tool for various neurosurgical procedures such as aneurysm clipping or spine instrumentation.
More than 3000 neurosurgical procedures were successfully conducted in the Hybrid ORs. We describe our experience of modified Digital subtraction angiography (DSA) system in the Hybrid operation room (OR).

Key words

• Endovascular treatment
• Neurosurgery
• Operating room
• Image-guided surgery

2.　Clinical Application of Hybrid Theater to Thoracic Aortic Repair

Department of Radiology and Radiological Section of Medical Technology Department1)
and Department of Cardiovascular Surgery2), Oita University, Faculty of Medicine
Norio Hongo, Tomohiro Hamada1), Ikuya Takagi1), Noritaka Kamei, Rieko Shuto
Katsuki Oji, Hiro Kiyosue, Shunro Matsumoto, Shinji Miyamoto2), Hiromu Mori

Abstract
While open aortic repair has been a standard procedure, thoracic endovascular aortic repair (TEVAR) has gained acceptance as an alternative for high-risk patients. The combination of the surgical operation and endovascular repair (hybrid therapy) enhanced the utility of TEVAR and broaden the indication of the treatment of the aortic disease because of its lower mortality and morbidity due to its lower invasiveness. In the treatment of the hybrid therapy, dedicated angiographic suites in the operative rooms (Hybrid Theater) have been popular in worldwide. We describe here the efficacy and utility of hybrid treatment in thoracic aortic disease with the utility of dedicated hybrid theater.

Key words

• Stent-graft
• Endovascular
• Thoracic aortic aneurysms
• Hybrid therapy

3.　Clinical Application of a Hybrid Operation Room for Abdominal Intervention

Department of Radiology and Thoracic and Cardiovascular Surgery1) and Obstetrics and Gynecology2),
Wakayama Medical University
Akira Ikoma, Motoki Nakai, Hiroki Minamiguchi, Tetsuo Sonomura, Kentaro Honda1)
Yoshiharu Nishimura1), Michihisa Shiro2), Sawako Minami2), Kazuhiko Ino2)

Abstract
Hybrid endovascular interventions offer several advantages by maximizing the procedural benefits and minimizing invasiveness. Hybrid endovascular procedures include a range of vascular interventions such as endovascular abdominal aortic repair, endovascular thoracic aortic repair, and transcatheter aortic valve implantation. The indications for hybrid procedures have expanded in recent years. A hybrid operation room (OR) has the benefit of enabling endovascular inter vention and surgery to be performed simultaneously under general anesthesia in a clean clinical setting. As the anesthesiologist manages the patient’s vital signs easily in hybrid OR, the interventional radiologist (IVRist) can concentrate on the procedure.
We describe hybrid abdominal interventions that involved collaboration between a surgeon and an IVRist. The hybrid OR at Wakayama Medical University Hospital is increasingly being used to perform procedures in which the IVRist cooperates with specialists such as vascular surgeons, gynecologists, urologists, and emergency physicians.

Key words

• Hybrid operation room
• Interventional radiology
• Endovascular abdominal aortic repair

4.　Clinical Application of Multiple Interventional Procedures
with a Hybrid Operation System in Kobe University Hospital

Department of Radiology, Center for Endovascular Therapy, Kobe University Hospital
Masato Yamaguchi, Takuya Okada, Eisuke Ueshima, Keitaro Sofue
Yutaka Koide, Naoto Katayama, Tomoyuki Gentsu, Ryuichiro Tani, Koji Sugimoto

Abstract
This article describes the original procedures performed using a hybrid operation system in Kobe University Hospital. This system is being used for the following inter ventional procedures: percutaneous isolated hepatic perfusion chemotherapy (PIHP) for advanced hepatocellular carcinoma, balloon occlusion and emergent embolization for placenta accreta, combination with endovascular intervention and surgical treatment for peripheral arterial disease, interventional procedures for managing portal vein disease using the trans-ileocolic approach, and combination with trans-catheter embolization and percutaneous sclerotherapy for arteriovenous malformation. In a hybrid operation room, there are many procedures that interventional radiologists could contribute to and should take an active part in.

Key words

• Hybrid operation system
• Multiple interventional procedures
• PIHP
• Placenta accrete
• PAD
• Trans-ileocolic approach
• AVM

Original Article

Predictive Factors Associated with Local Response of Hepatocellular Carcinoma after Chemoembolization with Epirubicin-loaded Superabsorbent Polymer Microspheres

Cancer Catheter Treatment Center, Kishiwada Eishinkai Hospital
Akihiko Seki, Hideo Ishikawa, Misaki Ryuge
Department of Radiology, Gate Tower Institute for Image Guided Therapy
Shinichi Hori, Satoru Sueyoshi, Atsushi Hori

Abstract
The purpose of this retrospective study was to evaluate predictive factors associated with local response of hepatocellular carcinoma (HCC) after transarterial chemoembolization with drug-eluting beads (DEB-TACE). A total of 123 HCC patients without intrahepatic metastases underwent DEB-TACE (50-100 μm superabsorbent polymer microspheres, 1 mg epirubicin/mg microsphere), and 338 nodules measuring ≥1 cm in longest diameter were selected as target lesions for nodule-based analysis. Local tumor response was evaluated 3 months after initial DEB-TACE according to the modified RECIST criteria. Univariate analysis showed that longest diameter of ≥ 3 cm, peripheral location, selective embolization, DEB dose of ≥ 10 mg, and no previous conventional TACE were factors significantly associated with better response. On multivariate analysis, longest diameter of ≥ 3 cm (odds ratio [OR]: 2.8; P = 0.001), peripheral location (OR: 2.1; P = 0.008), selective embolization (OR: 2.2; P = 0.003) and DEB dose of ≥10 mg (OR: 2.1; P = 0.006) remained significant predictive factors. All nodules were divided into three groups according to longest diameter (1–2 cm [n=125], 2–3 cm [n=97], and ≥ 3 cm [n=116]). Response rates were 44.8％ , 67.0％ , and 82.8％ in the 1–2 cm, 2–3 cm, and ≥ 3 cm groups, respectively. A longest diameter of ≥3 cm, peripheral location, and selective embolization using a sufficient dose of DEB were significant predictors of response after DEB-TACE.

Key words

• DEB-TACE
• Response
• Epirubicin
• Superabsorbent polymer microspheres