Moving from HD to 4K sounds easy, but it can be a big deal. And it can be a big headache if the transition isn't done right. Here at UMass Memorial Medical Center, we recently upgraded to ultra-high definition surgical video, investing around $2 million for 19 4K towers. From running a trial to training our surgeons and staff, here are 7 tips for a successful conversion to 4K video.

1. Know when it's time to upgrade. I loved the HD video equipment that we had when it came out. I liked the screen and picture and my eyes were used to it. But we realized a few years ago that it had outlived its age because, among other things, reliability became an issue. There were some pauses in the images, the wiring was going bad, camera heads wouldn't read correctly and the colors would be off and you'd have to adjust them. The images just weren't as sharp.

When those glitches happened during procedures, we had backup, but there was a lot more service required with more frequency. And because it was old equipment, that made it more difficult to maintain and service. Even the company was saying there was only so much it could do to keep it working. Bottom line: HD was a workhorse for us, but it was time to change horses.

2. Do a trial run. Yes, we all know that a 4K video image is 4 times the resolution of regular full HD, but nothing compares to seeing it for yourself on a 55-inch 4K UHD monitor. You can go to conferences and see presentations, but until you see it in the OR, you can't appreciate the sense of immersion that brings you closer to every detail.

We invited 3 major companies to come in for a 2-week trial so we could test their cameras, light sources, insufflators and monitors. Around 30 of our physicians and staff who work in our 24 ORs over 2 campuses trialed and rated each product using a number scale. We had paper forms with a brief questionnaire and our comments to fill out each day that we used the equipment. The questionnaires were then collected and cumulated. Among the things we rated were the setup of the system and its usability. As you might expect, physicians looked closely at image quality while staff keyed in on setup and ease of use.

Not everybody agreed on everything. But there was enough consensus to narrow the choices to 2 companies, whom we asked to come back in for an additional trial period. We eventually decided that image was the most important feature for our purchase. Looking at the big screens, we said, "?Yeah, we gotta have that.' For laparoscopic surgery, sight is the most useful and important sense, even more so than touch. We believed that image is king, so we wanted a system that gave us the clearest and sharpest image.

3. Prepare for technical difficulties. Equipment issues don't disappear after installation. The solution for us: an on-site troubleshooter. Our contract included a manufacturer-employed tech who is stationed on-site at our hospital for 3 years. We wanted a true expert here who could troubleshoot for us when things go wrong and who could get us back on track quickly.

In the first 6 months, having someone on site was key and he was called to the OR more frequently in the beginning. Sometimes we had a problem with the image or the light quality. Occasionally there was a camera head or light source problem and he would have to determine if it was user error or (more rarely) if it needed to be traded out.

The tech also worked closely with the physicians on image enhancement and contrast levels and fine-tuned what each physician wanted to see. We are now getting more into recording and maybe moving pictures into our electronic medical records. The tech will be involved in the integration of those aspects.

4. Be patient with the learning curve. Everybody learns at different speeds, and that can be frustrating. "Why does this system do this, the old system didn't do it that way?"

One example for us was insufflation. On our previous tower, insufflation was something that we could activate on and off from the surgical field. But it's not that way with our new system. A circulator has to turn insufflation on and off from the monitor because the button on the tower is not in the sterile field. It's a small thing, but still an inconvenience.

The manufacturer of our 4K system is a great imaging company, but there's a sense they're still working on how best to integrate the components of the tower to the surgeon in the field. I also suspect that the manufacturer assumed we'd have more OR staff than we actually do. In our world, one nurse is running around doing 100 things. Now they've had to learn one more task, that of pressing a button at a certain time.

Once people get used to the differences and learn by using the equipment more, they understand the various programs and buttons and what they'll do and can appreciate more of the positive aspects of the system. It took us about 2 months to master the learning curve, but having on-site troubleshooting helped in that regard as well. The learning curve might have taken a little longer otherwise.

5. Accept different strokes. Everyone has a picture preference. It's like when you go into a TV store and look at the rows of TVs. Some images look better than others to you and you can't imagine why another person would like an image that doesn't appeal to you.

You can go into the OR and find that somebody has programmed the screen with a different red balance or warm feature. You realize people see things differently and have different settings. I've been told that I like more of a warm feature and a warm image. Others like more of a contrasted, sharper image. It all comes down to personal preference. The good news: You can save each surgeon's image settings and preferences under each surgeon's name.

6. Start everybody equally. When we converted to 4K, everybody got to use the new video equipment. We were all at the same starting point. When we first got HD, we bought only so many pieces, but not enough for everybody. It was a financial issue. When the HD technology came in, the image was better and the towers were more functional. But only some people were getting to use the new equipment at the time and that created some ill will among the surgeons and staff.

A surgeon would come in for a procedure and say, "Why don't I have the new equipment?" And that would become an issue. Even if some people were doing a basic laparoscopy, it wasn't fair to say hey, you're not important enough to have the new technology. I saw that then and it wasn't right.

So when we made the conversion from HD to 4K, everybody got an opportunity to use the new equipment from the beginning. That equality was one of the aspects in making for a smoother transition.

7. Check out the deals. Because of the size of our order, we were able to purchase some integrated towers that also had endoscopic capabilities on them and rolled that into our package. The more we bought, the greater the discount. But in the end, price was an important factor, and we believed we were getting a lot of bang for our buck with what was emerging technology at the time.

The 4K perspective

Keep these tips in mind when it's time for your docs to trial a 4K system. But don't lose sight of the true benefit of big-screen surgery: surgical outcomes. Providing your surgeons with wide-angle views of clearer, true-to-life images of the surgical field will help your staff provide better and safer care. OSM