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When surgeons operate, they want to see exactly where their instruments are heading and view the patient's anatomy in crisp, true-to-life detail. Thanks to high-definition imaging, they can. It creates a sharper picture, larger image and better depth of field, and lessens the tunnel vision surgeons often experience when looking at standard-definition monitors. Since surgeons see more of the surgical site in more detail, they have the confidence to perform faster, safer surgeries. If you've never watched surgery in high-def, it's time to schedule a screening in your facility.
Better image, less glare
Standard-definition surgical monitors have small depths of field, which limit a surgeon's peripheral view of the surgical site. He has to navigate around tissue and organs slowly, carefully feeling his way. It's like driving in fog. You can barely see beyond the car's hood so you drive slower, cautiously pushing forward.
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High-Def: A Clear-Cut Favorite |
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We added high-definition displays to the booms in 2 of our operating suites to give surgeons a better image that could help improve operating efficiencies and patient outcomes. High-def video creates a larger depth of field, which improves the surgeon's peripheral view as he moves instrumentation in and out of the surgical field. Since we've upgraded to high-def, we've received rave reviews from our surgeons about the improved image quality and wider view of the surgical site. We're still in the process of gathering efficiency data, but since the upgrade our operative times per case have decreased by 2.5%. We looked at 4 vendors' proposals, then narrowed the field to 2 systems that we trialed in our facility. We found little functional difference between the 2 systems. The system that we decided to purchase had the lowest total cost of acquisition and was the one our surgeons preferred and found easiest to use. If you're thinking about upgrading to high-def, consider these tips: Determine what you'll really use. You don't want a system that will be obsolete in a few years, but you also don't want to invest in a lot of flashy, expensive features. We recommend limiting your equipment specification list to the system configurations and features that your surgeons will use most often. Our goal was to purchase equipment that would work well for 4 to 6 years and that would be adaptable as technology evolved. This approach eliminated several components of the vendor-proposed configurations that we received, such as an external camera system, which is more suited to academic institutions, or voice activation, which we had on a previous system and found more cumbersome than a foot-pedal control. In the end, we settled on a basic system with a light source, camera, telescope, camera head, monitor and image management system (see "Tale of the Tape" on page 21 for the exact specifications of the system we purchased). Consider adding an image management component to your HD system. It can help streamline how images flow in and out of your facility. Integrating image management with an external PACS system lets you easily send digital images to and from surgeons' offices and wherever they're needed in your facility, saving surgeons and staff from having to carry films back and forth. Know the total acquisition cost. Compare vendors' bids based on how much their systems will cost in the long run. Basic acquisition costs include the equipment price, financing expenses and equipment maintenance programs. If you're able to purchase disposables and implants from the company that's providing your HD system, you might be able to leverage that purchasing power into significant cost savings on your HD system. For example, while trialing HD systems we made note of the disposables and implants sold by the competing HD vendors and discussed standardizing those supplies throughout our surgical suites. As a result, we successfully established a medical supply purchasing arrangement in partnership with the HD equipment vendor we ended up buying from, which helped reduce the total acquisition cost of the upgraded system. Our HD equipment ran us about $115,000 per OR. Negotiating a contract that standardized our disposables and implantable screws and anchors sold by the HD vendor saved us about $67,000 per year or $335,000 over the 5 years we expect to use the equipment. In effect, the implant and disposables savings cover the cost of the HD equipment. Get diverse opinions. Today's healthcare environment demands you make prudent investments in high-utility technology using flexible platforms. You can improve patient results and surgeon effectiveness with a systematic assessment and purchase of high-def technology. Including surgeons in your trialing process is essential, but don't ignore the opinions of clinical coordinators, materials managers and other facility leadership. Each person brings unique expertise to the discussion and will provide assessments through different filters — such as supply costs or ergonomics — that provide you with valuable insights that might differ from the end user. — David Davies, MHA, and Thomas Ellis, DO Mr. Davies ([email protected]) is chief executive officer of University Orthopedics Center Surgical Services in State College, Pa. Dr. Ellis ([email protected]) is an orthopedic surgeon and shareholder in the University Orthopedics Center. |
Operating in high-def, meanwhile, is like driving on a clear, moonlit night. A high-def image provides 6 times more visual information than a standard-definition image of the same size. On the monitor that translates into a wider color palette and better definition of tissue topography. The surgeon, as well as the rest of the surgical team, can clearly see blood vessels on organs as well as the sharp edges of surgical instruments that can nick them.
Blood reflects light and, when viewed on many standard-definition displays, can cause a saturated red glare that obscures the surgeon's view. On high-def displays, blood doesn't glow as brightly, which helps the surgeon see what he's doing and work more efficiently. Less overall glare can also help prevent visual fatigue, which affects surgeons who spend many hours each day staring at monitors.
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Tale of the Tape | ||
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Here's a detailed breakdown of the HD system purchased by the technology assessment team at University Orthopedics Center Surgical Services in State College, Pa. |
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Component |
Purpose |
Specifications |
Light Source |
Illumination (brightness and contrast) for visualization of anatomical structures and instrumentation control |
300 watt xenon light source |
Camera CCU |
Image capture, processing and routing |
SD and HD input and output, digital video interface (DVI), serial digital interface (SDI) |
Telescope |
Image acquisition and resolution diameter |
Lens diameter and diffraction (greater lens generates larger bandwidth of information) |
Camera Head |
Image performance |
Optical zoom (magnification) |
HD Monitor |
Image display |
1080p |
Image Management |
Captures and controls images |
PACS image transfer and display |
Screen test
Many young surgeons who have grown up using computers and playing video games are extremely comfortable using images on monitors to guide their movements. Older surgeons, however, sometimes have a harder time adapting their skills to image-guided techniques. High-def helps bridge the gap between aging docs and their younger colleagues by improving the speed, accuracy and confidence with which most surgeons who use the technology operate. When operating in high-def, both skilled and less-skilled surgeons go faster, but the less-skilled surgeons make greater strides in their surgical efficiencies.
At Cedars-Sinai Medical Center here in Los Angeles, we confirmed that surgeons' efficiencies improved when they operated in HD and reported our findings in the October 2007 issue of Surgical Endoscopy. We asked 53 surgeons to perform a series of laparoscopic tasks using a surgical simulator. They performed the tasks while watching their movements on both a high-def and a standard-def monitor. Knot-tying times improved for surgeons who did well on baseline hand-eye coordination tests. Times also improved for surgeons who didn't rate as highly on the hand-eye test. However, when working with high-def monitors, the knot-tying times of the less-skilled surgeons improved at a greater rate than the times of highly skilled surgeons.
The results were similar when surgeons performed hand-eye coordination tasks on the simulator using their non-dominant hands. Surgeons performing tasks with their non-dominant hands did slightly better when looking at a high-def monitor, especially among the average-skilled surgeons.
All surgeons know that high-def imaging systems are expensive and require a serious financial commitment from your facility. But if your HD choice is well considered, the return on your investment will be realized with improved clinical efficiencies and increased surgeon satisfaction.
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