A Clear Look at the State of Surgical Video

Surgical Video and Imaging Healthcare IT

By: Natalie Hope McDonald | Contributing Editor

Published: 4/19/2022

Share:

Ultra-high definition is by far the top choice for facilities, but the adoption of 8K is coming.


When Apostolos K. Tassiopoulos, MD, performs vascular surgery at Stony Brook (N.Y.) University Hospital, he has what some might consider an unfair advantage over the competition that allows him to deliver standout outcomes time and again. That’s because Dr. Tassiopoulos, who serves as Stony Brook’s interim chair of the department of surgery and director of the hospital’s Vascular Center, operates in a hybrid OR that uses a high-definition (HD) imaging system that integrates 3D images with crystal-clear video. “It serves as a roadmap, and it allows us to have a continuous outline of the target vessels,” he says.

Dr. Tassiopoulos believes HD systems lead to improved surgical outcomes by helping surgeons to perform more accurate procedures, shortening surgical times and reducing radiation exposure in a minimally invasive platform. In addition, patients also tend to have less pain and much shorter recovery times thanks to the technology, according to Dr. Tassiopoulos.

Stony Brook’s hybrid ORs are the epitome of what video systems should be for facilities: a technological tool that enhances providers’ ability to deliver superior outcomes for their patients. There are several imaging options on the market today — and one on the horizon — designed to deliver on that goal. 

• Ultra-high definition. The first and most common of these HD systems is based on 4K resolution, which lets surgeons see tiny details of anatomy more clearly and operate more efficiently. At Pikeville (Ky.) Medical Center (PMC), a new 4K system was introduced to meet the newest goals of an evolving OR — one of which, according to President and Assistant CEO and CMO Aaron Crum, MD, was to increase precision, particularly during laparoscopic and arthroscopic surgeries. Overall, the new system provides four times the resolution and twice the color quality of standard high definition. It’s currently being used for a range of surgeries including orthopedic, bariatric and gynecologic. “The color and contrast provide more clarity. It’s much better than we’ve seen before during an operation,” says Grady Stephens, MD, a general surgeon at PMC. “The clear images allow an improved dissection of tissue and enhanced evaluation of tissue perfusion.”

PMC’s move to 4K seems to be consistent with outpatient and hospital systems that are upgrading their video systems because the difference from previous standard definition is quite stark, says Suraj S. Soudagar, MS, MBA, LEED AP, principal and project executive at IMEG Corp. in Naperville, Ill. “If you look at standard-definition imaging and a high-definition 4K system, you’ll notice a major difference,” he says.

• 4K/3D combinations. 3D imaging, often used in conjunction with 4K, is also becoming more common in surgical facilities. It can be used in many procedures, but it’s particularly useful when it comes to robotics and endoscopy. Ochsner Health System in Southwest Louisiana is another example of a facility that upgraded its video system recently. William Richardson, MD, an Ochsner surgeon who specializes in bariatric and general surgery, uses both 3D and 4K technology and says one of the most notable benefits of the high-resolution video systems has been the decrease in surgical stress levels because of the extra layer of confidence and precision HD affords surgeons. He also contends the enhanced quality and detail of the 4K/3D video system ultimately translates into better overall surgical outcomes.

If you look at standard-definition imaging and a high-definition 4K system, you’ll notice a major difference.
— Suraj S. Soudagar

The 3D imaging technology used in conjunction with 4K aids in many of the bariatric surgeries Dr. Richardson performs because it can show minute details that can sometimes be lost using previous iterations of video systems. “Having transitioned to operating in 4K, we can see what’s really happening with tissues. We can see blood vessels better. Moving to these technologies has made it easier to perform surgeries,” says Dr. Richardson. “I think 4K and 3D are a significant improvement from the older systems.”

• The future of 8K. In recent years, 8K has also been reshaping medical devices within the surgical world thanks to its ultra-high-definition images created from 33 million pixels, which is essentially 16 times more detail than standard 4K images. To put that into perspective, 8K cameras can capture objects as small as one-tenth the size of a human hair. An 8K system also makes it possible to observe the finest anatomical details, all the way down to the cellular level.

HYBRID THEORY Apostolos K. Tassiopoulos, MD, in one of Stony Brook (N.Y.) University Hospital’s state-of-the-art hybrid ORs, which integrate 3D images with HD video.  |  Stony Brook Medicine

Most 8K technology, however, has primarily been used outside of the U.S. — in countries like Japan. Some Japanese hospitals are equipped with 8K surgical microscopes that provide 300 times magnification with interchangeable lenses that can be used for so-called “super microsurgeries.” For example, at Tokyo Women’s Medical University, a Smart Cyber Operating Theater (SCOT) is in place that includes a mobile OR mounted on a truck that’s outfitted with 8K high-resolution video. The captured images can be sent in real time via 5G to a strategy desk where experts are standing by to consult on treatment. The goal is to have the mobile OR reach patients in places where they can be treated quickly, with the benefit of having experts guide the surgery. It can also help in situations where there is a shortage of medical care and personnel.

Although the potential of 8K video in health care is mostly theoretical right now, there are industry experts who envision 8K revolutionizing the way surgeries are performed on micro vessels and lymphatic systems. The technology could also be a game-changer when it comes to remote surgery, particularly when combined with the power of 5G. The ability to share ultra-high-definition video via a wireless network could potentially change the way surgeries are performed just about anywhere and in concert with multiple expert sources.

Of course, the ultimate value depends on whether health systems are willing to make the leap when 4K has thus far been a reliable system and a relatively new upgrade. Right now, there doesn’t seem to be a compelling reason to move to 8K. “Facilities are not rushing to invest in 8K. There is a very minor incremental difference between 4K and 8K in terms of surgical performance,” says Mr. Soudagar. “How much zoom do you need on a liver or to see vessels and tissue planes?” 

He believes the visualization quality needed to perform effective surgery is sufficient with 4K, so 8K upgrades are currently cost prohibitive. In other words, the financial investment needed for 8K is not necessarily worth the total payoff.

Does that mean we won’t see 8K systems in ASCs and HOPDs down the road? Absolutely not. In fact, Mr. Soudagar predicts that 8K could become the standard when the hardware catches up to the technology. At this time, though, full 8K capabilities are somewhat limited outside of Japan. For 8K to gain widespread usage in the U.S., more surgical vendors will need to upgrade the elements of their imaging chains — such as flat screen monitors and surgical cameras — to support this more advanced resolution.

When it comes to cost versus benefit, there’s a reason 4K is currently more widely adopted at facilities across the country: The difference in resolution between standard definition and 4K is noticeable. Plus, the prices are coming down for new 4K systems. “They’re not even as high as they were two years ago,” says Mr. Soudagar. OSM

Related Articles