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).

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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.

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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 intervention 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.

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This article describes the original procedures performed using a hybrid operation system in Kobe University Hospital. This system is being used for the following interventional 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.

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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.

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