Behind the scenes of a
life-saving surgery
Sunnybrook’s vascular team and a grateful patient recount the first surgery in the Blake & Belinda Goldring and Family Hybrid Operating Room
On January 13, 2022, Sunnybrook’s vascular team came together to perform the very first surgery in the Blake & Belinda Goldring and Family Hybrid Operating Room, the first of its kind at Sunnybrook.
Here, lead surgeon Dr. Andrew Dueck, his colleagues and grateful patient Endre offer a rare look into what transpired over the 24 hours before, during and after the life-saving procedure.
It was a moment years in the making, and one made possible by lead support from Blake and Belinda Goldring and the Giovanni and Anna DeGasperis Family (Michael, Carlo and Silvio), who along with Dr. Robert Maggisano inspired Sunnybrook’s community to realize this vision.
January 12, Afternoon – The perfect storm
The new and highly transmissible Omicron variant was surging across Canada. Just a week earlier, Ontario had paused all non-emergent and non-urgent surgeries in order to preserve critical care and human resource capacity – and prepare for a rapid increase in COVID-19 hospitalizations.
Sunnybrook vascular surgeon Dr. Andrew Dueck was examining a patient in urgent need.
Endre, aged 77, was a hairdresser who loved long-distance cycling, riding up to 100 kilometres three times a week. He had fled to Canada as a political refugee from Budapest, when he was 20 years old.
Dr. Dueck learned that Endre’s care team had been monitoring an abdominal aortic aneurysm – what’s often called a “triple A.” Part of the wall of Endre’s aorta, the artery that carries blood from the heart throughout the body, had weakened, causing the vessel to balloon out. Since it was first discovered in 2014, the aneurysm had remained stable without any symptoms.
But that wasn’t the case anymore. Now at eight centimetres, Endre’s aneurysm was already the size of a small eggplant – three or four times the typical size – and quickly growing. Without immediate surgery, Dr. Dueck feared it would rupture.
January 12, Evening – “We’ve got to do this”
Sunnybrook’s operating room (OR) team had just completed a full-scale setup and testing of the new hybrid operating room custom-designed for complex surgical repairs, like triple As.
The Blake & Belinda Goldring and Family Hybrid Operating Room combines a surgical theatre, an angiography suite, a cardiac catheterization laboratory and an imaging suite, making it possible for multidisciplinary surgical teams to work in tandem on patients with multiple, competing care priorities.
Sunnybrook’s Goldring Hybrid OR and the OR team were both ready to go. They just needed a green light for the first case. Dr. Dueck insisted it be Endre.
Dr. Dueck. “Endre was in urgent need, and it was time to give it a test drive. I thought, ‘We’ve got to do this.’”
The decision was made and Endre learned his surgery would take place the following morning.
January 13, 6:45 a.m. – Prepping the room
The vascular OR nursing team arrived early to set up the Goldring Hybrid OR for Endre’s surgery. Circulating nurse Susan Berrezueta and scrub nurse Cecilia Anglacer prepared two surgical tables: One to support the first phase of the procedure to isolate the femoral artery in the patient’s groin; and a second outfitted with the equipment Dr. Dueck would need to feed a catheter through the artery and into the aorta.
This would allow Dr. Dueck to reline the weakened section of the arterial wall with a stent graft. Dr. Dueck described it as “fixing the plumbing without digging up the front yard.”
There was a feeling of excitement in the air. The vascular team was buzzing with anticipation during a team huddle down the hall.
7:15 a.m. – Unprecedented precision
In the adjacent control room, the team activated the image-guided surgical system that Dr. Dueck would use to visualize the vessels and position the stent. Called a “C-arm” because of its shape, the mobile system uses advanced X-ray technology to allow surgeons to operate with unprecedented precision.
The team selected the custom parameters for Endre’s surgery, including magnification, field of view, angulation (the angle or bend in an organ) and intensity, which Dr. Dueck had finalized prior to surgery.
7:26 a.m. – Comfort when it matters most
Endre had been prepped for surgery in his Sunnybrook room and wheeled to the pre-op room just outside the Goldring Hybrid OR. Dr. Dueck met with Endre to explain the procedure one more time and to answer any questions.
“I told Endre we’ve done this surgery many times, but this was a first for this room and equipment. If you hear us talking, pay no mind, we’re just getting acquainted with the new equipment and finding the new buttons,” says Dr. Dueck.
“Dr. Dueck gave me a lot of comfort. I am fairly anxious most of the time, but I felt comfortable going into the hybrid operating room because of Dr. Dueck and the nurses, who were all so reassuring,” remembers Endre.
8:15 a.m. – Surgery begins
The team was now ready to begin a carefully orchestrated dance. Endre had been brought into the Goldring Hybrid OR and positioned on the specialized EVAR (abdominal endovascular aneurysm repair) table, where Susan, Cecilia and a nursing student hooked up various heart rate, blood pressure and respiratory monitors and added an intravenous line.
Once he was satisfied that the patient was stable, Sunnybrook anaesthesiologist Dr. Keith Tanner administered general anaesthesia. The surgery was now underway.
8:30-10 a.m. – “Just spectacular”
Assisted by the OR nursing team and fourth-year vascular surgical resident Dr. Brandon Van Asseldonk, Dr. Dueck made a 4-centimetre-long incision at the leg crease by the patient’s groin. The team lowered the lights and moved the mobile C-arm into place above the patient’s mid-section. All eyes were on the imaging screen as Dr. Dueck fed the catheter through the incision, into the artery and up to the abdominal aneurysm.
Dr. Dueck then inserted a stent graft – a fabric tube supported by metal wire stents – into the catheter. Guided by the X-ray images, he carefully threaded the graft into the aneurysm. Dr. Dueck expanded it so it pressed against the sides of the blood vessel and fastened it into place to form a stable channel for blood flow.
In the final step before closing, the surgeons injected a dye into the artery to confirm there were no obstructions and that the stent wasn’t blocking the renal arteries.
Dr. Van Asseldonk agrees. “When we use the words ‘precision’ and ‘personalized care,’ this is what springs to mind. The detail, it was just mind-blowing. Unlike anything I’d ever seen before.”
11:30 a.m. – Recovery and discharge
Once in recovery, Endre was watched over by a team of specialized recovery nurses until he was awake, stable and ready for transfer to Sunnybrook’s surgical floor. On January 15, 2022, Endre was discharged home with a clean bill of vascular health and just a handful of stitches to show for his experience. He would have routine follow-ups with Dr. Dueck over the coming months and year.
“Looking back, it was an absolutely wonderful experience,” Endre says. “I never felt scared. Everyone took time and care with me, to explain the procedure before I went into the hybrid operating room. Everywhere I looked, it was state-of-the-art, spotless and clean. I get emotional thinking about it. Everyone did a wonderful job of caring for me at Sunnybrook.”
A closer look
The Blake & Belinda Goldring and Family Hybrid Operating Room has triple the functionality and double the space of a standard OR.
The highly specialized and integrated space has a wide range of state-of-the-art equipment, so multidisciplinary teams no longer need to transfer patients with multiple complex injuries between the operating room for surgery, the angiography suite to stop bleeding or the imaging suite for diagnostic guidance.
Now Sunnybrook’s teams are even better equipped to take on the province’s most complicated surgeries, supporting patients with urgent and often competing needs involving the brain, heart, spine, cancer or major blood vessels, as well as high-risk mothers and babies.
Surgeon-in-Chief Dr. Avery Nathens explains: “Some procedures are best done in an operating room; others in a catheterization lab or imaging suite. Too often, we were faced with a difficult decision: Operating room or imaging suite? Thanks to Sunnybrook’s donors, we can now do it all in one place.”
