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Does Size Matter When It Comes to Surgical Displays?
A bigger screen size is nice, but that's not all surgeons care about.
Miroslav Uchal
Publish Date: January 31, 2017   |  Tags:   Surgical Video and Imaging
bigger and brighter screen BIG AND BRIGHT Rule of thumb: The bigger and brighter the screen, the better off the surgeon will be.

Surgical displays have made big strides in a remarkably short amount of time — emphasis on the word big. We now have these gorgeous 55- to 60-inch screens with resolution and magnification tools most of us never would have thought possible. As a result, surgeons — not to mention our patients — have been the beneficiaries of shorter procedure times and improved outcomes.

But how do you choose the surgical display best suited for your OR? As a general rule, the bigger and brighter the screen, the better off you will be. The screens I currently work on are 32 to 36 inches, and I use every single inch. Of course, most of us will always want more. I recently trialed a 55-inch screen for 2 weeks, and it was an unbelievable experience. The picture was so big and clear that the distance from me to the screen almost didn't matter.

That having been said, the biggest screen might not always be practical in terms of the procedure, the size of the OR and, of course, the cost. In 2017, a 40- to 45-inch display should be the standard for laparoscopy, because it's big enough that you can see everything you need to see, but it's not so overbearing that it's obstructing the movement or workflow of the surgical team. So yes, the size of the screen is a vital consideration, but it's hardly the only one. You should also weigh the following key variables.

Image quality
Just look at how 4K ultra high-definition has changed the game. With 4K, which is 4 times the resolution of traditional HD, you have the potential for incredible visualization, where you can magnify something on the screen 10 to 30 times, with virtually no pixilation. During one procedure, I measured 1 inch on my instrument, and it came up measuring 29 inches on the screen. In my world, this can be incredibly advantageous when it comes to suturing for revisional bariatric surgery or other tasks that require the utmost care and precision.

surgical display DECISION TIME Choose a surgical display based on factors such as screen size, image quality and adjustability.

I love 3D, and I wish I had it for everything. If I don't have 3D for a particular case, I might hesitate because I feel slightly uncomfortable. A 2015 study published in Obesity Surgery that compared 2D to 3D in laparoscopic bariatric surgery showed that surgeons experienced better depth perception and reported less strain with the 3D system, especially during longer procedures. I've found that 3D reduces OR time.

Given the size, brightness and contrast of today's screens — OLED (organic light-emitting diode) should be the standard — I no longer have to operate in a dark OR. I can use the ambient green lights or, if they're not available, just leave the overheads on. As a result, my eyes are no longer tired and red after a long surgery. And because of the improved visibility in the OR, there's less chance of tripping.

Adjustability
One of the great challenges surgeons face is that every surgeon must use the same surgical display. Whether you're right-handed or left-handed, tall or short, or prefer 2D to 3D, every surgeon is unique and has his or her preferences. My point is that surgeons need flexibility. When I do a laparoscopy, I typically place the screen at eye level or lower; it's uncomfortable for me when the screen is higher than that. I also keep the screen next to the patient, maybe 2 yards away. Another surgeon who's doing the exact same surgery might have a preference that's the complete opposite of mine. That's why it's so important to get involved in the purchasing process, to make sure whichever system you select has the flexibility to accommodate the preferences of the docs who'll be using it every day.

Durability
Where will the screen be positioned during the surgery — in the sterile field or up against the wall? Depending on how you answer that question, you need to consider design features like edge-to-edge glass that is both splash proof and scratch-resistant. Also, any surgical display within the sterile field should be able to withstand exposure to disinfectants and other liquids to assist with infection control. Lastly, the display shouldn't be too big to prevent other members of the surgical team from effectively doing their jobs. (See "Mapping Out the OR" below.)

VISUALIZE IT
Mapping Out the OR

physical mockup HOPSCOTCH, ANYONE? Physical mockups, like this spray-painted layout of a new patient unit at Rush University Medical Center in Chicago made at an adjacent tennis court, can help determine the optimal placement of displays and other medical equipment.

When it comes to vetting surgical displays, consider this advice from Carrie Condry, IIDA, LEED AP, EDAC: "Function follows form," she says. "Try to think through every detail," including the display's location, positioning and any other factor that might affect how you go about the surgery. But don't just think about it, says Ms. Condry, a senior technology consultant with the healthcare-technology consultancy Mazzetti+GBA. Map it out.

Her firm tends to work with surgical teams on site to determine the placement of OR equipment, but circumstances sometimes dictate more inventive methods. Once, the firm built a mockup of an OR in an under-construction parking garage, using structural foam and PVC pipe. Multiple service lines — orthopedic, GYN and plastics, to name a few — used this mockup to run through surgical scenarios and determine optimal placement of boom-mounted displays and other technology vital to the OR.

Likewise, Richard Brink Jr., CTS-D, MS, director of information and communication technology for Genesis Planning, says physical mockups can be helpful complements to 3D renderings of an OR's vertical and horizontal space.

"A lot of physicians like to see how flexible their configurations are in a real, physical space rather than seeing it in a 3D drawing," says Mr. Brink. "In the past, we've taken a shell space and put up temporary walls and brought in a couple of different systems, basically creating a whole OR — or least most of it — so [surgeons] can see what's possible."

— Bill Donahue

Split-screen functionality
Picture-in-picture and split-screen functionality are musts for endoscopy. Projecting a CT scan or an X-ray into the corner of the screen is incredibly helpful because it gives you access to additional information that can affect the decisions you make, all without your having to leave the sterile field. Based on how integrated our ORs have become, you can project virtually anything — a consent form or an H&P, for example — onto the screen.

Yes, the past few years have brought about some incredible advances in terms of screen size, clarity and functionality, but it's likely only the beginning. Where do we go from here?

Regardless of whether surgical displays go much bigger than 60-inch screens, I think we'll likely see monitors continue to slim down and become less conspicuous, and maybe even transparent. And if what we're seeing in consumer technology is any indication, I expect we'll see a move toward curved screens, which could be helpful for wider-angle viewing. Wireless displays would be ideal, as long as signal reliability isn't an issue.

I would like to have seamless displays, where everything just drops down from the ceiling and then retracts when not in use. Or even a screen that hovers in front of me and moves if I turn my head more than, say, 20 degrees. We might also see significant progress in terms of the central control of OR functions. I expect there will be a day when I'm talking to some sort of artificial intelligence, saying, "OK, turn on the OR lights, turn on the insufflator, rotate the surgical display from portrait to landscape," and, much like Apple's Siri or Amazon Echo's Alexa, it will promptly respond by making those adjustments. OSM

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