The Bright Future of 4K Video

Robotic Assistance Surgical Video and Imaging OB-GYN

By: Adam Taylor | Senior Editor

Published: 11/15/2021

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State-of-the-art imaging systems increase surgical precision and contribute to improved outcomes.


Charles E. Miller, MD, FACOG, had already sold his surgical team on the 4K video platform he wanted for performing same-day minimally invasive gynecologic surgeries. The hospital’s administrators who controlled the purse strings for the major purchase were next.

He ushered the group into an OR and showed them the brilliant ultra-high-def imagery displayed on a bank of large wall-mounted monitors. The leaders were amazed by the colors of the tissue, the ability to see anatomical landmarks and the depth perception that allowed them to differentiate various tissue planes. 

“I was leery about upgrading from standard high-def, because it’s a big ask,” says Dr. Miller, founder and president of the Advanced Gynecologic Surgery Institute in suburban Chicago. “But the ‘wow factor’ was amazing. Shortly after leadership saw the presentation, they said it was a done deal. When you can get administrators excited about spending a large amount of money, that’s a wonderful moment.”

It was also a good moment for his patients. The 4K system allows him to make more precise cuts that lead to faster and safer procedures. “It’s not surprising to me that studies have shown that operating in 4K results in an increased speed of navigation in the surgical space, which results in less operative time,” says Dr. Miller. “Surgeons can be more precise, which is why the research shows 4K reduces procedural errors and patient blood loss.” 

Dr. Miller has been performing gynecologic procedures since 1983 and has seen the full evolution of minimally invasive surgery. He says the improvement in image quality between standard high-def and 4K has provided surgeons with the biggest technological bump yet. Going from regular 2D to 3D imaging was advantageous, he says, but nothing like what he’s experienced in the two years that he’s been using 4K imaging chains.

Dr. Miller believes 4K technology is particularly helpful during gynecologic surgery. Removing uterine fibroids during a myomectomy, for example, can involve significant blood loss, which can lead to a “red out” in the surgical field. This is where 4K accompanied with image-enhancement systems can help. Image enhancement makes what’s being displayed on the monitors appear sharper and uses a brightness-adaptation feature within the image to show a clearer view of darker regions. “The enhanced visualization, increased contrast and ability for side-by-side comparison of captured images make the blood in the field much less of an issue, and that’s a huge advantage,” explains Dr. Miller.

He says the increased depth perception provided by 4K systems during conventional laparoscopy rivals what he experiences during robotic surgery. “I see the benefits hundreds of times a year,” he says. “When I’m better able to visualize vessels and see tissue planes, I can do procedures more quickly and effectively.”

Ultra-high-definition video allows for the use of green light fluorescence, which lights up critical anatomical structures to increase their visibility. Dr. Miller and his team are also about to study a device devised by a urologist to better identify endometriosis in the vaginal wall and rectum. “Our ability to test that technology is based on the increased image quality we have now,” he explains. “The future is bright for 4K, that’s for sure.” 

Wynn-Win

BRILLIANT IMAGES 4K systems provide surgeons with visualization that is far superior to anything they’ve had at their disposal in the past.  |  John Martin-Eatinger

Investing in 4K can be lucrative in other ways, too, according to Suraj S. Soudagar, MS, MBA, LEED AP, principal and project executive at IMEG Corp., a healthcare engineering firm in Naperville, Ill. He’s part of new build that will replace two Mohawk Valley Health System (MVHS) hospitals in Utica, N.Y., a small city nestled between Syracuse to the west and Albany to the east. One of the hospitals is nearly 70 years old and the other has been around for more than a century.

“They don’t have modern air conditioning systems, let alone state-of-the-art imaging technology,” says Robert C. Scholefield, MS, RN, the health system’s executive vice president, whose sole job is overseeing the new hospital project. The 670,000-square-foot main building is about 45% complete. Full construction is expected to be done by July 2023 and patients are scheduled to be relocated from the existing hospitals in October 2023.

The hospital will have larger ORs and brand-new equipment, including 4K video systems throughout. Leadership decided the imaging upgrade was needed after conferring with consultants and their frontline surgical teams. The consultants told them 4K technology would be needed to recruit top physicians to Utica. MVHS surgical staff noted that the current equipment was beginning to fail, experiencing problems with screens fogging and had an overall lack of image clarity.

MVHS is also building a surgery center on its campus in partnership with a private physicians group. Whether the ASC’s ORs will be outfitted with 4K is an open question, as the physicians must agree to adding the technology, but MVHS leadership would like the facility to have the same video technology as the new state-of-the-art hospital, says Mr. Scholefield.

He says the health system’s surgical, interventional radiology, advanced endoscopy and cardiology personnel explained why they needed better imaging technology for better diagnoses. 

“Our surgeons made the case that they needed 4K to navigate more precisely in smaller anatomical areas to be more precise and make better diagnoses,” says Mr. Scholefield. “We decided to make it available to them and, quite frankly, they’re thrilled. They feared we would invest in a lesser technology.”

The leadership also realized that 4K would be necessary to get the best candidates in the system’s general surgery residency program, which will launch when the new hospital opens.

The choice to create a high-tech hospital had a significant multiplier effect. The project caught the attention of Las Vegas casino mogul Steve Wynn, a Utica native, who heard about the project, became curious, and was impressed with its high-tech aspect. That led to a $50 million donation. The Wynn dollars aren’t being used for actual construction. Rather, they’re being allocated for programs to target and retain physicians. “Mr. Wynn was happy that we were building a facility with high levels of technology and wanted to help recruit providers we might normally not be able to attract,” says Mr. Scholefield. 

Looking ahead

COLOR CONTRAST Surgeons can distinguish one tissue structure from another through green light fluorescence imaging.

Outpatient facilities associated with hospital systems are more likely to be in the market for 4K systems, according to Mr. Soudagar. He says hospital-funded projects tend to be larger in scope and have bigger budgets, while independent facilities are more likely to keep a watchful eye on every dollar.

Mr. Soudagar was involved with the imaging upgrades made to the OR where Dr. Miller operates. Around the same time, he met with a plastic surgeon who wanted to expand his practice from a hospital outpatient department to an ASC. “He said he wanted 4K imaging, an integration system and light booms,” says Mr. Soudagar. “But when he discovered the price tag of all the components, he compromised on some features that were originally considered crucial components of his desired setup.”

Thankfully, says Mr. Soudagar, the cost of imaging technology will change in the coming years. While the decision to purchase 4K will always be a tug of war between clinical needs and what facilities can afford, eventually prices will drop from the approximate $75,000-per-OR price tag for a 4K system with a single video scope.

Adoption rates could also rise as 4K systems include additional features. At least two manufacturers have incorporated smoke evacuators into laparoscopic camera heads to ensure the sharp images the systems provide are able to be seen. “The scopes absorb the smoke that is created when surgeons cut and ablate tissue,” says Mr. Soudagar. “That effectively keeps the surgical field clear, so surgeons maintain excellent visualization while they’re working.”

He believes even facilities that aren’t in hyper-competitive markets face increasing pressure to add 4K imaging systems, which serve as a recruitment tool for top surgeons who completed their residencies at major health systems that had the technology in place and expect to operate with the latest highest-quality video. 

“There will come a point in which the market will be flooded with 4K platforms and standard definition technology will no longer be available,” says Mr. Soudagar. “It happened with TV sets, and it will happen with OR systems.” OSM

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