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Advances in Video Imaging
The days of laparoscopic surgeons feeling as though they're operating through a straw are long gone.
Pamela Ertel
Publish Date: July 9, 2015   |  Tags:   Surgical Video and Imaging
high-resolution view 4K ULTRA HD A crisp, clear, high-resolution view is essential for laparoscopic surgery, says gynecologic surgeon Jeffrey B. Frank, MD, of the Reading Hospital SurgiCenter at Spring Ridge in Wyomissing, Pa

For more than 20 years, imaging technology remained virtually unchanged. Then along came high definition, which quickly became the new standard in OR video. We all longed for the image quality, amazing clarity and depth of field of HD in our ORs. But now there's ultra high-def, or 4K Ultra HD as it is known. Ultra high-def has 4 times the resolution and a significantly wider color range than 1080p. It's difficult to describe the resolution and clarity of 4K. Some have likened it to wearing glasses for the first time: All of a sudden, you can see much more. Others say it feels like you're taking a 3D-like tour of the knee, shoulder or uterus instead of looking at it on a 2D screen.

"I would liken it to going to a movie when I was a kid 100 years ago compared to going to an IMAX today. It's night-and-day different," says gynecologic surgeon Jeffrey B. Frank, MD, one of the original owners of our surgery center. Interesting analogy, Dr. Frank, for the IMAX movie experience is often described like this: You're no longer at the window peeking out; you're outside among the stars.

"It clearly identifies and sharply delineates what we're looking at," adds Dr. Frank. "The color is the real color of the organ and the adjacent organs. It's live. It's as if I was looking directly at the image in situ as opposed to on a television screen."

Besides the clear view, 4K's lifelike quality will also help our surgeons with such depth-perception activities as suturing or separating tissue. For arthroscopy, endoscopy and open surgery video imaging, 4K has transformed our 8 ORs from rooms to theatres. I can already tell you that the sharper, clearer images promote better surgical outcomes, case efficiency, and patient and surgeon satisfaction.

The next big thing in surgical visualization
We spent nearly half a million dollars on our new OR video system. $489,000 to be exact, on 7 consoles, 7 tablets, 12 camera heads, 12 fused light guides, 4 26-inch high-def monitors, 7 UHD4K monitors, 7 digital printers and 3 video carts with boom arm extensions. We also purchased an assortment of varying sizes and degrees of arthroscopes and laparoscopes to replace our dated and much-utilized scopes.

I love that the camera heads are fully autoclavable. We'll save around $6,000 a year because we're able to steam-sterilize the cameras. We also negotiated a 7-year warranty on the camera heads, which will save us close to $100,000 (the warranty would have cost us $13,600 a year). Our vendor also cut our service contract in half.

Our video system is amazingly compact and doesn't make a substantial footprint in the OR. I liken it to a "video tower in a box." It integrates 3 components — high-def cameras, an LED light source and an image management system — that used to be available as separate systems into one console that uses an Apple iPad tablet interface. Having one console and one interface simplifies use and makes it easy to accommodate individual surgeon preferences, which we can store on the cloud.

We had long wanted to upgrade our video imaging equipment, but we have the Pennsylvania Department of Health to thank for really spurring us into action. The state DOH granted our surgical center an exception to perform laparoscopic vaginal hysterectomy and laparoscopic supracervical hysterectomy. The imaging equipment we had was sufficient, but we knew it was time to invest in the latest technology. If we're going to do these advanced GYN procedures, we want to be sure we're really keeping patients safe by providing our physicians with the best possible tools. Last month we hosted our first laparoscopic hysterectomy. The procedure went very smoothly, with excellent patient outcomes. I attribute the success in large part to our new video equipment.

Complex laparoscopic surgery is difficult to master. This is made harder by the fact that you must interpret a 3-dimensional environment on a 2-dimensional viewing screen. Dr. Frank says he was able to perform the case faster and safer thanks to our OR video system because he didn't have to take extra steps and precautions to avoid surgical complications. On our old equipment, Dr. Frank could clearly see the uterus. With the new gear, though, he can see every vessel and every lump and bump on the uterus. Our system identifies, in real time, the dark areas in an image and automatically adjusts pixels to lighten hard-to-see anatomy. We paid an extra 20% for the 4K upgrade.

"But it's worth it," says Dr. Frank of the 4-times-greater resolution. "It's like buying last year's new car. If you're buying a new car, you want it to be new for as long as it can be new. The same thing goes for state-of-the-art equipment."

4K & 3D
How Likely Are You to Upgrade Your Video Imaging?

Margaret Chappell, MS, BSN, CASC, senior vice president of operations with ASCOA in Charleston, S.C., is "very likely" to buy 4K video. "Physicians will want state of art," she says. "They always want the latest and greatest."

On the other hand, Teressa Polcha, RN, BSN, CNOR, same day services director of Somerset (Pa.) Hospital, says she's "very unlikely" to invest in 4K and 3D visualization. "We just bought high-def 2 years ago," she says of the struggle to justify the cost and clinical benefit of upgrading to the latest video imaging equipment.

"It depends on cost, and does it really help," says Sylvia Sherry, RN, BSN, MSN, CNOR, the materials manager at Summit Surgery Center in Santa Barbara , Calif.

When we asked a panel of 36 facility leaders how satisfied their surgeons are with their laparoscopic video equipment, most (77%) were "very satisfied" or "somewhat satisfied." When we asked how likely they are to upgrade to 4K and 3D video capabilities, only about one-fifth said they were "somewhat likely" or "very likely" to buy.

"We don't have the money to keep buying the latest next big thing," says one facility manager.

"I'm sure the surgeons would like to upgrade to better equipment, but they're okay with using what we have," says Doris Terwilliger, RN, surgery manager at Guthrie County Hospital in Guthrie Center, Iowa.

— Dan O'Connor

Apple iPad tablet interface
Built into our system is an image management system that securely routes still images, video and data to any network location, including our PACS and EHRs. The system lets our physicians instantly transmit any videos or still images taken during the cases over to an iPad, and use those to create quick post-operative patient presentations, then e-mail the post-operative reports. This feature really helps you move your ORs to paperless interfacing with your patients.