Revolutionising Complex Surgery in Mexico’s Public Health System
The introduction of a state-of-the-art hybrid operating theatre in Mexico aims to redefine the landscape of complex surgical procedures within the public health system. This facility is equipped with real-time imaging systems, advanced assistance technology, a platform for minimally invasive operations, and capabilities for remote medical training. The overarching goal is to enhance the precision and efficiency of surgical interventions, reduce operation times, and shorten hospital stays. However, questions remain regarding the evidence supporting this model’s efficacy and its potential contributions to a high-demand public emergency service.
Few scenarios demand as much speed and accuracy as a surgical emergency. This is a daily reality at the Hospital General de Xoco in Mexico City, where IMSS Bienestar has recently launched what is touted as the largest intelligent operating room in Latin America. The emergency department provides free services to an average of 300 patients each day, the majority of whom arrive due to traffic accidents—a leading cause of death among children and young adults aged 5 to 29 globally.
Amidst this backdrop, the Surgical Innovation and Precision Surgery Centre has been established, designed to facilitate diagnosis and treatment within the same operating theatre. Chantal Zambrano, head of Telehealth at IMSS Bienestar, notes that by integrating medical and informatics technology, the theatre optimises workflow and enhances collaboration among teams. Furthermore, she highlights that simultaneous procedures can be performed in cases of polytrauma, which translates into reduced long-term consequences for patients.
Innovative Procedures in the New Hybrid Theatre
The first patient treated in this new facility was Yolett Cervantes Cuaquehua, a 21-year-old from Veracruz. Remarkably, she had recently won a ticket to attend the inauguration of the 2026 World Cup, where she represented President Claudia Sheinbaum. Yolett, an avid football player for ten years, had suffered a ligament injury two years prior during a match, resulting in persistent pain and instability in her knee.
The arthroscopy of her knee was performed by Miguel Ángel Guillén, head of the hospital’s joint surgery department. He recalls the early days of his career, where diagnosing conditions involved developing X-ray films. The new operating room now features a state-of-the-art mobile CT scanner, capable of capturing detailed images from multiple angles. A software programme then compiles these images into a three-dimensional representation that guides the intervention in real-time, allowing for surgery without the need to transfer the patient.
While Yolett’s surgery was planned, the hospital frequently deals with emergencies. In this regard, Zambrano emphasises that hybrid theatres enable quicker location of injuries and minimise transfers between different areas, thereby reducing the risk of complications and expediting the start of procedures.
Potential Benefits of Hybrid Operating Rooms
The ability to obtain images during surgery allows for real-time verification of the procedure’s progress and its outcomes before completion. According to a report from the Canadian Agency for Drugs and Technologies in Health, based on systematic reviews, these capabilities may decrease the necessity for reoperations. The same document indicates that hybrid operating theatres can contribute to lower complication rates. While evidence regarding time reductions when using hybrid theatres varies, a study conducted in Denmark found that integrated theatres reduced preparation time for lobectomies compared to conventional theatres, although operations to remove gallbladders took longer.
Other studies have indicated that for severe traumatic brain injuries, hybrid rooms within emergency departments can shorten the duration of emergency surgery, and are associated with a reduced likelihood of adverse outcomes. A retrospective analysis revealed that implementing a hybrid operating room in trauma settings was linked to earlier control of bleeding, fewer early blood transfusions, lower rates of infectious complications, and fewer days on mechanical ventilation.
The surgery performed on Yolett utilised part of the comprehensive system for minimally invasive operations, which includes high-resolution cameras applicable across nearly all specialties. Arturo González Ledesma, national coordinator of supervision, emphasises that these technologies will facilitate shorter hospital stays, which translates into reduced rates of hospital-acquired infections and fewer adverse events, thus enhancing the overall quality of care within the hospital and the system.
Advanced Technologies and Their Integration
The hybrid theatre also boasts cutting-edge anaesthesia machines and a neurosurgical microscope featuring technology that enables clearer visibility of delicate anatomical structures, thereby preventing damage to healthy tissues. Additionally, it includes automated functions and intraoperative fluorescence to visualise tumours and assess the health of veins and arteries in real time.
Jesús Ortiz, the state coordinator of IMSS Bienestar in Mexico City, describes this operating room as an ecosystem where every component is interconnected, allowing for monitoring and coordination of operations from a touchscreen. “These arms are custom-made, rotating 360 degrees; we can adjust all the lights and equipment to ensure the patient remains still while the environment adapts,” he explains.
Future Prospects: Tele-mentoring and Precision Medicine
While the hybrid theatre is indeed a sterile environment, its analogy with an ecosystem falters in that regard. However, it shares with ecological systems the interaction of its components with their surroundings. Technologies within the theatre function as part of a system that shapes actions, with specialists, screens, and visualisation technology exchanging information in real time, even involving remote specialists who can assist with procedures or learn from the operations occurring in the theatre. This connectivity enables the management of medical images and data for future reviews and research, and in the short term, it can reduce preparation times.
In addition to the operating room, a teaching classroom has been established, where resident doctors will observe interventions in high definition and monitor the patient’s condition in real time. This classroom is separated from the operating room by a switchable glass wall that can transition from opaque to transparent with electric current. Zambrano emphasises that this connectivity “will allow support for personnel from lower-capacity units and collaboration with experts from other hospitals.”
Challenges and Considerations for Implementation
The centre has also incorporated Versius, a robotic surgery system featuring four arms controlled in real time by surgeons for minimally invasive procedures. Zambrano indicates that the system includes an internationally assisted platform powered by artificial intelligence that records surgical performance metrics, such as movement efficiency and frequency. This data is used to generate evaluations and recommendations for optimising techniques.
The first such system received FDA approval in 2000, and by 2023, more than a million robot-assisted surgeries were conducted annually. Despite its widespread adoption, randomised clinical trials—considered a standard for assessing the efficacy and safety of medical interventions—have only recently begun to accumulate. A systematic review published in 2025 analysed 33 of these trials and 121 studies from real-world evidence, finding that robot-assisted surgery often takes longer than laparoscopic procedures. In contrast to open surgeries, however, it is associated with less blood loss, fewer postoperative complications, and shorter hospital stays, albeit with longer operational times.
In joint replacement surgeries, current evidence suggests robotic assistance enhances the precision of the approach. Nonetheless, its long-term clinical benefits for this procedure are modest, and it has not consistently demonstrated superior safety compared to conventional surgery regarding major complications. Overall, robotic surgery offers advantages such as improved visibility, tremor filtration, and enhanced dexterity for operating in confined anatomical spaces. However, available evidence suggests that these advantages do not automatically translate into better clinical outcomes, with the impact largely dependent on the procedure and the surgical team’s experience. Notably, a consistent finding is that this technology associates with increased direct costs.
Addressing Safety and Training Challenges
The expectation is that work from hybrid operating rooms will foster innovative surgical methods. However, realising this promise requires addressing several challenges.
One concern is radiological safety. Zambrano points out that the integrated mobile CT scanner uses lower radiation doses than conventional equipment, including portable units. Another issue revolves around data protection, as these theatres generate and store sensitive images. Zambrano explains that the operating room operates on a closed network, “an internal data centre, separate from the institutional network.” Patients will be informed and required to consent to the use and storage of data for educational purposes.
An article published earlier this year in Humanities and Social Sciences Communications—a journal by Nature—highlights some ethical concerns surrounding the hybrid system. These include the recording of audio and video by the medical team, the redistribution of responsibilities as technologies evolve, and the legal implications of Big Data regarding data ownership and cybersecurity.
Training presents another challenge for maximising the potential of these facilities. Zambrano states that while staff are familiar with the devices, the challenge lies in “beginning to sensitise ourselves to this ecosystem and managing the equipment as efficiently as possible.” The state coordinator indicates that 70% of the personnel expected to operate in this area have already been trained.
Given the high demand faced by the hospital, protocols will need to be established to determine which clinical cases will be addressed in this space. Additionally, the Hospital General de Jiutepec, also under IMSS Bienestar, boasts the country’s first intelligent hybrid operating room. Though smaller than the one in Xoco, it is expected that they will not be the only facilities of this kind in the country, making ongoing evaluation crucial. To monitor the impact and benefits of these investments for the institution, the population, and healthcare personnel, Zambrano indicates that they plan to implement a monitoring system.