TRIALS AND TRIBULATIONS Physicians at the Weston (Fla.) Outpatient Surgical Center use the HD video system chosen during their recent trial.

Surgical video is advancing at warp speed. The cameras and monitors that were gee-whiz yesterday are ho-hum today. "By the time the technology gets on your facility's floor, there's already 15 other systems that have better, more advanced technology than what you just chose," says Randy Huffman RN, MSA, CMPE, administrator of the Weston (Fla.) Outpatient Surgical Center.

With new developments in surgical video outpacing your ability to afford — and maybe even need — them, it's difficult to know when's the right time to pull the trigger on new equipment. If you're anything like the 68 readers we surveyed, you're sticking with your current video setup for 5 to 10 years before you replace it. And during that time, your docs are likely telling anyone who'll listen about the latest big and bright (and pricey) cameras and monitors they need to have in their ORs. But with these new platforms seemingly arriving every few months, how can you possibly keep up? To help you get a grip on what's worth the splurge and what you can wait to purchase, here is what some of your colleagues who've recently held trials are saying about the latest technologies.

4K is on the way
Promising brighter, clearer images, 4K is making a splash in the surgical video world. The technology has 4 times the resolution and depicts more true-to-life colors than full 1080p HD video. But facility managers don't seem convinced of the need to upgrade to 4K just yet. Our survey found that only about 9% of respondents have adopted 4K or are planning to this year, while 59% say it's something they might consider down the road.

Though more than 70% agree that 4K has the potential to improve visualization and increase surgeon satisfaction, managers are still hesitant. With few vendors offering "full 4K" systems — which include both monitors and cameras that capture the ultra high-definition images — many say they're holding off until competition increases and prices start coming down.

BRIGHT AND CLEAR 4K video systems promise higher resolution and brighter colors than full 1080p HD systems.

4K may not be for every specialty. Take orthopedics, for example. When the Southwest Ambulatory Surgery Center in Byron Center, Mich., trialed 4K, the reviews were mixed. In orthopedic cases with a lot of fluid, it was hard to see the difference between 4K and HD, says Lyle Phelps, BSN, RN, the ASC's administrator. "We found that the 4K blurred the image to the HD level for those cases," he says. "For general surgery, ENT surgery and hand procedures, there was a noticeably brighter picture. But our focus is in orthopedics, so it didn't make sense for us to spend the additional money on 4K."

The technology's higher cost is deterring many managers, especially when they compare its prices to the latest 1080p HD systems. "We looked at 4K, but once the physician-owners compared the image difference and the price difference between the HD and 4K, they went with the regular HD," says Cheryl (Skeet) Todd, RN, BSN, CNOR, CPAN, RNFA, director of outpatient perioperative services at the Texas Spine and Joint Hospital in Tyler, Texas.

But when you're only getting a new system every 5 to 10 years, it may be worth it to spend a little extra to have the latest and greatest technology. That way it potentially stays relevant a few years longer, suggests Mr. Huffman. During his trial, he says he felt like he got a "better deal" on the 4K system since "it was a better technology," though his physicians eventually decided to go with another company that didn't offer 4K.

ON THE HUNT
7 Tips for Finding the Right Surgical Video System

WHICH TO CHOOSE? With technology rapidly evolving, how do you pick the best surgical video system?

It's tough finding the right surgical video system. Randy Huffman, RN, MSA, CMPE, administrator of the Weston (Fla.) Outpatient Surgical Center calls trialing surgical video technology downright "painful." To make it a little easier, here are 7 tips from your peers.

1 Don't forget about your staffers. While staff input may be less important to your final decision than other factors like cost and surgeon preference, don't fail to consult with them and seek out their opinions. After all, they're the ones "highly involved in the use, cleaning and troubleshooting" of the system, as one manager says.

2 Don't leave it open-ended. Have defined timelines and specific questions in mind to ask physicians after they trial the systems, says Mr. Huffman. "My process was open-ended, where I would ask them to just try and tell me what they liked," he says. "Instead, it would have been better to be rigid and say, 'Let's put a timeframe on it, and we need a decision by this day.'"

3 Consider the perks. Respondents note that multi-specialty facilities should look for a system that works across specialties to save money and boost efficiency, while others suggest you consider features like autoclavable cameras, mobile apps, image storage capabilities and a great set of support staff.

4 Take rep relationships out of the equation. Mr. Huffman says that in his trial, he thought that the reps' relationships with physicians played too large of a role. "Don't buy an OK system just because the right person is selling it," he says. "Caution your surgeons to take their relationship hats off when it comes to the reps and instead put their business hats on for the good of the facility."

5 Get aggressive with vendors. The best way to meet your budget is to pit vendors against each other — and to make sure they know about their competition. "Unless you're locked into something, it's definitely beneficial to pit companies against each other," says Lyle Phelps, BSN, RN, administrator of the Southwest Ambulatory Surgery Center in Byron Center, Mich. "It's a long process to bring in 3 or 4 companies to trial each one, but it makes a big difference when the quotes start coming in."

6 Look at the clinical benefits. Surprisingly, 13% of respondents say that studies backing up a manufacturer's claims are not that important to their final purchasing decision. But, several managers note that this research can help you determine if a technology is a good value in terms of cost versus expected benefits.

7 Don't forget about printing. Mr. Huffman notes that by upgrading his system, the center went from purchasing generic photo paper from the local office supply store to having to purchase special cassettes for the towers, increasing his expected annual printing budget by more than $35,000. Double-check the fine print for printing costs, he stresses, or better yet, look for systems that will digitally send PDFs to patients and your EMRs.

— Kendal Gapinski

Is 3D falling out of fashion?
3D technology has entered into the surgical world in 2 ways: robots equipped with 3D video and independent, standalone systems where viewers wear glasses to give them the enhanced views. These systems promise to give surgeons better depth perception during procedures, which can be especially helpful for tasks such as suturing or separating layers of tissue.

While our survey finds that 3D is currently more prevalent than 4K, it also appears to be growing at a slower pace. Roughly 23% of respondents say that they have a standalone 3D system and 10% say they have 3D video through a surgical robot. About one-fourth say they may adopt the technology in the future, but the majority (38%) says they have no plans to ever add 3D video.

Managers acknowledge that there are potential benefits to using the 3D technology, including overall better visualization (79%), and improved accuracy and precision during surgery (61%). Those using 3D say that their surgeons want these perceived advantages. "It's not yet available in every OR, so there's a competition for resources," says one clinical director whose facility uses a standalone 3D system. Others, though, say they just don't see a need for it currently. "The surgeons just have no interest in it," notes one manager. Several also say that while their docs wanted 3D systems a few short years ago, surgeons now see them as "outdated" as other systems have advanced.

Beyond high-res images

Image enhancement systems look beyond higher resolution or improved depth perception, and instead attempt to show the viewer what the human eye can't see on its own. Several types of technologies are lumped into the "image enhancement" category. There are optical enhancement systems, such as narrow band or fluorescence imaging, which use either injected dye or filtered light to show contrast-enhanced views of the surgical surface. Some respondents say these are helpful to see a structure's blood flow or to help avoid bile duct injuries during laparoscopic cholecystectomies. Other systems use digital processing technology to brighten up dark areas of the anatomy, intensify colors or cut through the haze of surgical smoke during the procedure.

The options are piquing some managers' interest. About 18% say they're using a form of image enhancement technology currently or they plan to adopt one by the end of the year. Roughly 39% say they're considering it for future use, especially since you can use some systems with your current video towers. "Our equipment is getting dated but is doing the job we need," says one respondent. "Eventually we will have to buy new equipment and will probably purchase a enhanced system." Others are taking a wait-and-see approach. "Until data demonstrates efficacy, we will not adopt (image enhancement)," says Thomas Lyons, MS, MD, medical director of surgical services at Rockdale Medical Center in Conyers, Ga. OSM