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Is Your OR Up for a Best Picture Award?
Nothing matters more to your laparoscopic surgeons than the quality of the image on the screen.
Dale Burleson
Publish Date: March 3, 2015   |  Tags:   Surgical Video and Imaging
HD video CRYSTAL CLEAR HD video has revolutionized laparoscopic surgery, and new imaging systems continue to improve.

Laparoscopic surgery offers plenty of benefits to patients, but they don't come without a big challenge for us surgeons: visualization. While HD has revolutionized laparoscopy, innovations like 3D and 4K promise to take us that much further in our imaging capabilities. These advanced imaging platforms coupled with enhanced laparoscopes mean our sight during surgery is constantly improving. Apart from drawing surgeons to your facility and increasing their efficiency, these technologies may also help to improve patient safety. Overall, there's a pretty basic principle driving these advances — if I can see better, I can do a better job.

HD is essential for improved images
By far, the most revolutionizing technology for laparoscopy in ORs today is high-definition video. Most facilities are now equipped with HD imaging systems, and several are on their "second wave" of equipment as things have become outdated. Besides offering a higher resolution, I believe that HD video has been a huge step forward for patient safety. While it's not clinically proven, it seems like common sense that it's easier for a surgeon performing a laparoscopic cholecystectomy to confuse the bile duct for the cystic duct when looking at standard images over HD ones. Ask any physician and you'll hear a similar story — HD's clearer, crisper images make it easier to cut, seal, suction, suture and do just about everything else laparoscopically.

HD systems have become standard in many ORs, but that doesn't mean they aren't constantly improving. Laparoscopes' designs have been updated to make them smaller and compatible with 5 mm ports, and many new scopes feature ergonomic enhancements like single-hand control. Personally, I like all-in-one designs where the light cable and camera system are contained in one unit, since they're easier to use and require less maintenance. Just like your iPhone camera, their optics are also improving, with newer models offering better lighting and resolution than their predecessors.

see better, do a better job

Scopes are also becoming more specialized. One example is laparoscopes that are being made to fit our increasing bariatric patient population. When I first started in the field, performing a laparoscopic procedure on a bariatric patient meant using instruments that felt too short and made it harder to see. Now, 45 cm length scopes can give surgeons better access and images of the abdomen.

Articulating scopes are another advancement that offer an easy way for a surgeon to see more angles with the touch of button. Articulating scopes are becoming more prevalent, especially as new platforms — including many 3D systems — require their use. They offer more angles and the latest "chip on the tip" technology for a sharper focus. These scopes mean you won't have to switch out a zero-degree rigid laparoscope for a 30-degree one several times during a procedure, saving time and maintaining your view. However, this technology comes at an added expense, and many experienced surgeons, including me, find using angled non-adjustable scopes to be comparable, if used correctly.

While today's HD monitors are a huge improvement over the small, standard ones of the past, they continue to improve. LED screens offer brighter images than traditional LCD ones, and many of the newer models contain several input ports so you can view a larger range of information at once. To more easily view split screens, larger monitors go all the way up to 50 inches, although those aren't always practical for minimally invasive suites. If you're shopping for new monitors, look at the size of your OR as well as whether the surgeon will be splitting the screen to view multiple images at once, and how many people will be in the OR at one time.

Manufacturers are looking beyond offering a higher resolution to improve a surgeon's sight. One company offers narrow-band imaging, which uses special blue and green filters to help highlight the blood vessels while performing surgery. Since tumors have more blood vessels than tissue, the imaging systems using this technology claim to help a surgeon more easily see small tumors. Another technology introduced by one manufacturer is meant to identify dark areas on an image and automatically adjust the pixels on the screen to lighten hard-to-see anatomical structures. There's also a system on the market that uses infrared light so as not to emit heat that can damage tissue. The signal, the company says, can be seen through up to 12 mm of tissue.

If your surgeons are still staring at splotchy small screens, you may want to look into upgrading to a new HD system that can offer additional features. While there are cool new advances, like 3D, that are generating buzz in the field, offering a quality HD system is a cheaper way to increase your surgeons' satisfaction and efficiency, and most importantly, add another level of patient safety.

3D: The future of laparoscopy?
While HD video is a must when it comes to improved laparoscopic visualization, 3D is a cool advancement that has been taking the field by storm. Full HD systems may be a big improvement for imaging, but surgeons still lack depth and spatial perception. 3D systems have been touted as a way to fix that.

A big push behind this technology was the growing popularity of robotic systems that use the 3DHD technology. To keep up, manufacturers have developed new laparoscopic imaging systems that offer the benefits of 3DHD video without the price tag of a robot. While robot systems deliver binocular views of the 3DHD video into a viewer for the surgeon, individual 3DHD laparoscopic imaging systems allow more surgical staff members to see in 3D by wearing polarized glasses.

The newest 3D imaging systems have also worked to improve the ergonomics of laparoscopic surgery. Most of these systems offer all of the bells and whistles tech-savvy surgeons crave, like big, bright monitors and articulating scopes with chip-in-the-tip technology. Some systems also are able to switch from 3D to 2D imaging with the push of a button. Sleeker, polarized lenses have also replaced big, bulky glasses that traditionally came with these systems.

Compared to HD video for traditional laparoscopic procedures, I've found that using a 3DHD system gives me more clarity. The benefits are evident when suturing or separating fine tissue in the abdomen, since the 3D lets me see the layers of tissue more easily. That said, I think 3D systems offer a bigger benefit to newer surgeons or residents, since they may help reduce the steep learning curve that often comes with performing laparoscopy using 2D images. If you're considering 3D, keep in mind that systems can cost well over $150,000. That may seem expensive, but these platforms are ideal for smaller facilities that want the technology but not the cost of a $2 million robot.

And while 3D is making a splash, 4K is what some are hailing to be the next biggest thing. Promising a lifelike look inside the body, this ultra-HD is meant to offer 4 times the resolution of traditional full-HD systems. It's not widely available yet, as manufacturers continue to perfect monitors and cameras practical for minimally invasive suites that won't bust your budget, but that doesn't mean many surgeons aren't excited for this next wave of visualization. Many say the images are like looking at something with the naked eye. While I haven't seen 4K personally, I imagine the same principle applies with this latest visualization improvement — the better the image, the better my performance.

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