THE PERKS OF HIGH-DEF A 4K surgical video system not only gives surgeons a better view but can also act as an effective recruitment tool.

Little Rock (Ark.) Surgery Center took a bold step forward last year by investing in a 4K surgical video system with "fabulous visualization," as administrator Kim Hamma, RN, puts it. For the multispecialty center's 2 surgeons who have embraced the system, Ms. Hamma says there's just no turning back now.

"An orthopedic surgeon is the primary user, and he absolutely loves it," she says. "I also let one of our general surgeons use it one day, and now I can't pry it out of his hands. It gives them a much better picture, but in some respects it's a new toy for them, too."

Just like the TV screens gracing the walls of our living rooms and bedrooms at home, the surgical displays in our ORs have gotten increasingly bigger and blessed with amazingly vibrant, life-like images that give surgeons hyper-realistic views of the surgical field. These larger-than-life displays and the ultra high-definition visualization systems that power them have also gotten much more costly. But are the benefits they bring to the OR — even beyond the significantly enhanced views — worth the expense? Let's see what they bring to the table.

From 3D and 4K to image-enhancement technologies and 55-inch surgical displays, the views are better than ever.

3D. Perhaps most useful for laparoscopic procedures, 3D surgical video systems can improve a surgeon's hand-eye coordination and enhance depth perception. These systems are particularly robust when used in conjunction with robotic surgical systems.

Although standard HD is standard issue in most of its ORs, the Emory Clinics in Atlanta, Ga., uses 3D in some service lines to give surgeons better views of certain anatomical structures. Likewise, Chestnut Hill Hospital in Philadelphia, Pa., uses 3D surgical video in conjunction with a surgical robot. The benefits of the investment, says Lynn Truitt, MSN, RN, NE-BC, CNOR, CASC, administrative director of perioperative services: higher resolution and clarity; more precision and accuracy; improved patient outcomes; and higher patient satisfaction.

4K. A 4K ultra high-def picture offers nearly 4 times the picture quality of high-def 1080p and nearly 10 times that of standard 480p. Clarity aside, 4K pictures can be magnified significantly without losing definition, meaning surgeons get an outsized, unparalleled view of the area in which they're operating.

"They may come out with something completely new next year, but I'm glad we made the investment in 4K," says Ms. Hamma. Interestingly enough, word has it that 8K may be on the near horizon in U.S. ORs (osmag.net/sFEMs5).

Big-screen bliss. Over-sized surgical displays offer opportunities for never-before-seen visualization and magnification, and most surgeons love the larger-than-life, crystal-clear detail. Even so, the increasingly larger surgical displays — 55 inches or more — can pose some challenges, especially in ORs where unused space is a rarity. But how big is too big? We're not quite there yet, says Vangie Dennis, BSN, RN, CNOR, CMSLO, administrator of The Emory Clinics.

"We've got 42- to 47-inch screens in all our ORs, and I think they will continue to get bigger," she says. "Who knows? One day they make take up an entire wall."

DECISION TIME
'Bright and Shiny' or 'Affordable and Practical'?

ONE SIZE FITS ONE Not every OR will benefit from — or be able to afford — next-generation surgical video.

???Last year, when SurgCenter Cleveland in Beachwood, Ohio, updated its surgical video system for use primarily in ENT procedures, 2 factors influenced the decision: surgeon feedback and affordability. 3D and 4K were both deemed cost prohibitive, so the center opted for traditional 1080p HD.

???"This was a good option we could afford," says Barbara Ann Cowling, RN, BSN, CNOR, RNFA, the center's director of nursing and clinical manager. "Our testimonial comes from our very first case we did with it in tryout. We found another entry into the patient's maxillary sinus, and we never would have seen it with our old system. Everybody wants the biggest and brightest, but you have to be practical."

???In other words, not every facility needs to invest hundreds of thousands of dollars in a shiny, new surgical video system.

"We're doing more and more things outpatient now, and that includes getting ready to do total knees and total joints," says Cherokee Moore, RN, nurse manager at a BayCare surgical facility in Trinity, Fla. "I anticipate our tower needs will increase, but we're still doing lap choles the same way we did 5 years ago."

Her point: "You don't always need the newest, latest and greatest like 3D and 4K."

— Bill Donahue

Image enhancement. Endoscopic fluorescence technology helps a surgeon make more informed decisions intraoperatively by visualizing features that are invisible under conventional white light — differentiating between healthy tissue and malignancies, for example. Also, in colorectal surgery, the technology can assess bowel perfusion and evaluate vascular blood flow following anastomosis to avoid post-operative complications.

Intangible benefits
For Ms. Dennis, next-generation surgical video does more than just give a surgeon a better window into the surgery. She says it can also be a "huge" recruitment tool.

"Because of that, I think we will move faster than most centers in terms of the integration of new technology," she says. "These investments are mostly made for reasons surrounding safety and the quality of clinical outcomes, but you can't deny their impact on recruitment. You may not get a change in reimbursement, even though the cost is higher, but the return is there one way or another."

Many surgical video systems come with value-added features that can improve efficiency. Two of the most popular: autoclavable cameras, for quick turnover; and iPad apps, for ease of use.

Other considerations
Considering the hefty price tag that comes from equipping an OR with 4K, 3D or whatever iteration comes next — it could run $300,000 per room in the era of OR integration, says Ms. Dennis — this is not an investment to be taken lightly. Ms. Hamma's advice: Don't be shy about asking vendors for exactly what you need. Also, she says, stay flexible.

"I tell the vendors, 'I want the best deal, so come to me with your very best number,'" she says. "You'll have some back and forth, but this is not like buying a car. You have to be prepared to give a little in order to get a lot."

For example, you may be able to negotiate a more attractive price based on hitting certain thresholds on disposables. Also, if the vendor has an integrated business platform, with multiple products outside the realm of surgical video, an agreement to increase purchases of other products you already need may help to negotiate a better price on the purchase or lease of the surgical video system.

Speaking of price, Cherokee Moore, RN, nurse manager at a BayCare surgical facility in Trinity, Fla., cautions about cost creep tied to compatibility issues. "When you change the towers, you also have to change the scopes, the instrument trays and all the other accessories. So what we thought was $300,000 now is $350,000 or $360,000."

No matter what kind of make or model you're considering, never make the decision without buy-in from your surgeons, says Ms. Hamma. Her center trialed 2 4K systems, each one for about 6 weeks, in order to ensure her surgeons were satisfied with the chosen system before signing on the dotted line. OSM