Price is definitely a consideration when buying an endoscopic camera. All things being equal, a better price means a better buy. But keep in mind that image quality dominates the decision for clinical users. If your physicians know they'll have to struggle with your endoscopic cameras, they may go elsewhere. Here are some observations on endoscopic camera choices.

What does "three-CCD" mean?
Many endoscopic camera systems are marketed with the term "three-CCD" or, alternatively, "three-chip." This describes the method of technology through which images are processed.

A three-CCD camera contains three charge-coupled devices, one each to measure the red, green and blue light — the color components of video reproduction — given off by a subject. The light that enters the camera's lens is split by a prism, which signals the proper amount of each color to be represented in each pixel of an image to the corresponding CCD.

Three-CCD cameras are an advancement over single-CCD, or single-chip, cameras, where one chip manages all three colors. The more precise color reproduction comes at a price, of course, as three-chip cameras tend to be more expensive.

HD's the way to go
High-definition, as opposed to standard-definition, and digital, as opposed to analog, cameras are the state of the art right now, and if you buy brand-new equipment, it may be difficult to find anything that doesn't feature those technologies. If you're buying pre-owned or refurbished equipment, however, you might see some standard-definition models. If you're considering those choices, though, be aware of what resolutions your monitors and display equipment are capable of supporting, and keep in mind that more ORs are going — and more physicians are demanding — HD.

If you've seen the technology demonstrated in the exhibit halls of association conferences, you know what a difference it makes. A short review: HD incorporates as many as 1,080 vertical lines of pixels in an image, as compared to standard definition's 480, for a sharper resolution.

In the descriptive term "1080p," frequently used in product marketing to signify "true HD" or "full HD," the "p" stands for "progressively scanned," which means that each line is refreshed in each cycle, as opposed to interlace technology (seen in 1080i devices), where alternating lines are displayed in each cycle.

Image capture and display devices are also described in terms of "aspect ratio," which represents the image's width versus its height. An aspect ratio of 4:3 is squarer, like a standard-definition monitor or television set, while 16:9 is more rectangular or widescreen, and often adopted for high-definition uses.

Judging image quality
What's a surgeon looking for in an endoscopic camera's image? One major factor is the amount of illumination and clarity that's offered. In minimally invasive surgery, without sufficient illumination, you're working in darkness.

The importance of illumination is evident in the older, analog endoscopic cameras. You can still get the job done with the 10mm cameras, but the older 5mm cameras are now very limited in their usefulness: Their images are too dark and should a bleeding situation arise, the view goes virtually pitch black, leaving you blind in an emergency.

With a 5mm digital and especially with an HD camera, the image is very clear. In fact, when you're working through a trocar, there's a benefit to limiting the size of the camera, since a 5mm trocar means less risk of bleeding, hernia, pain and scarring than a 10mm or 12mm trocar. However, you can't compromise on image quality with a 5mm camera the way you might be able to with a 10mm camera. Otherwise your image will be too dark.

Similarly, in older, analog models you don't want to attempt to compensate for poor illumination by turning up the brightness of the image itself. Then you'll just end up with a subpar image that's too bright and still difficult to see. Ideally, you're looking for a camera that delivers a defined, clear image with no haziness, just as when you see a high-definition television demonstrated in a non-surgical environment.

Some cameras feature programmable pre-set options for use in different specialties, letting surgeons obtain optimal image capture and reproduction for laparoscopic, arthroscopic, ENT and other procedures.

A camera scope's ability to see at angles is another feature your physicians might find useful. The tips of many camera scopes are able to flex from the zero-degree, straight-ahead view to a 30-degree angle that widens the optical field with a slight turn. Some also allow a 45-degree-angle view, but this tends to be seen as a "luxury option," not a necessity, for most surgeries.

Handling and maintenance
An endoscopic camera consists of three parts:

• the camera control unit (sometimes referred to in marketing materials as "the CCU"), which is the box that's stacked on the video tower or cart;
• the camera head connected to the CCU (the cord of which may restrict physicians' mobility, at least until endoscopic instruments catch up with wireless technology); and
• the camera scope (often a separate attachment that connects to the camera head), which is inserted into the surgical site.

The ergonomics of the camera head itself when in use, the differences in control and hand position, are not widely different from product to product. Your surgeons will want to trial them in clinical situations, however, to test drive which are lightweight, easy to set up and to use. One safety note: The tip of the camera scope can get quite hot and can easily burn through surgical drapes to a patient's skin if mislaid.

Many manufacturers offer autoclavable camera heads, and this is a valuable feature, especially at physician-owned surgical facilities. There, cost-consciousness is high up on the ladder of priorities, in case turnaround as well as equipment turnaround. Being able to have several cases going at one time and to efficiently reprocess the equipment needed to serve them all via steam sterilization is a plus.

Lastly, don't neglect the importance of regular maintenance for your cameras. It's very clear when a facility has a bad service record. When new, an endoscopic camera's lenses are treated with a protective film that resists fogging during use, but over time, as the film wears away, the lenses tend to fog up more often, resulting in hazy images.

This means the surgeon or his first assistant will have to keep withdrawing the scope from the surgical site, wipe off the lens and replace it, and there are few things more frustrating during minimally invasive surgery. Some facilities aren't even aware of the need for servicing worn lenses, but don't make that mistake. A few dollars of regular maintenance can maintain your surgeons' attendance in your ORs.

ConMed Linvatec
IM4000 HD Camera System
(727) 392-6464
www.conmed.com
List price: IM4000 camera control unit, $25,000; IM4120 camera head (pictured), $25,000
FYI: ConMed Linvatec's IM4000 high-definition endoscopic camera system features 1080p native resolution for the clinical advantages of an HD camera system and a steam sterilizable camera head with durable ShockFlex prism mounting for the fiscal advantages of reduced ownership and service costs, says the company. Leveraging over 10 years of autoclavable camera design, the IM4000 system conforms to Advanced Television System Committee (ATSC) industry standards.

Genicon
High-Definition Surgical Camera System
(800) 936-1020
www.geniconendo.com
List price: $30,000 range, depending on volume
FYI: Lightweight, ergonomically designed and easy to set up and use, Genicon's 1080p HD camera includes presets for laparoscopy, urology, arthroscopy, hysteroscopy, ENT and flexible scope applications, says the company. Additional custom profiles can be tailored for specific surgeons or advanced users. Its resolution is 1920x1080 progressive via 3.33-inch widescreen format CCDs.

Karl Storz Endoscopy-America
Image 1 HD Camera Platform
(800) 421-0837
www.karlstorz-hd-endoscopy.com
List price: not disclosed
FYI: Karl Storz's Image 1 HD camera platform provides 1080p60 full HD, the highest high-definition standard for endoscopic video images, and 16:9 aspect ratio acquisition and display for clean, sharp visualization when capturing both slowly- and rapidly-moving images, says the company.

Olympus America
ViseraPro Autoclavable HD Camera System
(508) 804-2714
www.olympusamerica.com
List price: $37,750 for camera control unit and head
FYI: With 1,080 effective scanning lines of picture information, the ViseraPro high-definition, autoclavable camera head delivers picture quality that is more than four times the resolution of a traditional television, says manufacturer Gyrus ACMI, now a wholly-owned subsidiary of Olympus. Images are sharp and clear, with lifelike color reproduction and detail.

Richard Wolf
Medical Instruments
High-Definition Camera 5550
(800) 323-9653
www.richardwolfusa.com
List price: not disclosed
FYI: Richard Wolf's three-chip, HD endoscopic camera sports 1080p resolution and an ergonomic camera head that's comfortable to hold and easy to control, says the company. It is fully autoclavable for a quick reprocessing turnaround, and its vivid color brings true-to-life imagery to the surgeon.

Smith & Nephew Endoscopy
560 HD Camera Head
(800) 544-2330
www.global.smith-nephew.com
List price: not disclosed
FYI: Smith & Nephew's 560 camera head is built using broadcast quality, widescreen, HD technology, says the company. Its 3 CCD imaging features native 16-bit color depth, which expands the range of highlights, midtones and shadows visible to the user, as well as full 1080 HD resolution. Digital signal processing in the head ensures consistently accurate images and its ergonomic housing is designed for durability.

Stryker
1188 HD 3-Chip Camera
(800) 624-4422
www.stryker.com
List price: not disclosed
FYI: Stryker's 1188 HD 3-Chip Camera features a durable, ergonomic camera head that can be steam-sterilized for quick turnaround between cases, says the company. This camera has the flexibility to display both widescreen HDTV and standard HD aspect ratios in one camera system.