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Ultra High Definition Is Coming to the OR
Imagine seeing images at 4 times the resolution of today's high-definition video displays.
Dan O'Connor
Publish Date: December 20, 2013   |  Tags:   Surgical Video and Imaging
4 times the resolution of high-definition LOTS MORE PIXELS 4K denotes a screen resolution 4 times higher than current full HD screens, shown here, which means a far more detailed, sharper picture.

When Steven Palter, MD, performed the world's first high-def endoscopy in 2000, he was met with more jeers than cheers. "Everyone said, 'Why would you do this? What could you possibly see with HD in surgery that could be better than the fantastic images that we already have?'" he says.

And now that 4K ultra high-def surgery is just around the corner, Dr. Palter is again at the forefront of a visualization revolution. He predicts that this game-changing technology that produces images 4 times the resolution of today's high-definition video displays will transform surgery. "The transformation from HD to 4K will be as dramatic as the transformation from standard definition to HD," says Dr. Palter, an obstetrician, gynecologist, reproductive endocrinologist and fertility specialist who in 2009 performed the world's first 4K super high-definition laparoscopy at Syosset Hospital in Long Island, N.Y.

"Like looking with your naked eye into the body," says Dr. Palter, MD, medical and scientific director at Gold Coast IVF in Woodbury, N.Y. "The images are the sharpest, most detail-rich and color-correct endoscopic images ever created anywhere. There is not a more accurate view inside the human body. Every-one thought HD was as far as you can go, and what I showed them is this is just the tip of the iceberg."

The difference between HD and 4K?
"4K ultra HD? We still haven't upgraded to HD!" you're probably saying to yourself. Relax. HD might be perfectly fine for your ORs. "Getting by with good, but older technology," is how Dr. Palter puts it.

And it's not like HD is an outdated technology by any means. Just think: In 2000, most people didn't have HD yet in their homes. A frame of endoscopic video made by an HD camera and shown on an HD monitor has more than twice the number of scanning lines than a frame of conventional video does, making for much crisper images.

"Right now, the benefit [of 4K] has not yet been proven," says Dr. Palter. "There is nothing yet that increased resolution has proven you could do that you couldn't do before. But the more you improve your image, the better tool you give people to work with." Even though Dr. Palter says you need to have the best possible image that you can have and afford in your workflow, "I would still wait until you can't get by with what you have" before thinking of upgrading to 4K.

But if you still haven't upgraded to high-def cameras and monitors, we hope your surgeons enjoy staring at those dishwater-gray images on your dull video screens. Either that, or you're saving up and holding out for the next big thing: 4K ultra high-def, which will deliver 4 times the picture resolution of today's 1080p, full-HD displays.

4K is derived from a 3,840 x 2,160 pixel matrix, or more than 8 million pixels compared with HD's 2 million pixels. 4K is better than HD for the same reason that HD was better than standard definition: The more pixels you have on the screen, the better the image quality. Dr. Palter calls 4K "a fundamental change in resolution, color correctness, character and precision in the image."

Being able to see details and structures that were undetectable before translates into more accurate, error-free and efficient surgery, as well as less surgeon fatigue, he says. That's the promise of ultra high-definition laparoscopic surgery. One reviewer put it this way: "What [4K] means in terms of potential image clarity is more fine detail, greater texture and an almost photographic emulsion of smoothness. A 4K display reveals so much more nuance and detail — the difference can be astonishing."

In addition to the amazing resolution of HD endoscopic images, Dr. Palter notes that 4K can manipulate wavelengths of light — autofluorescence, near band, near infrared, narrow band imaging — to take you beyond what the eye can see. For example, using an autofluorescent system from Karl Storz Endoscopy-America, Dr. Palter was able to manipulate different wavelengths of light to see beyond the capabilities of the naked eye and diagnose otherwise invisible endometriosis. "Suddenly disease was glowing fluorescent green that would have otherwise been missed," he says.

dramatic transformation

Hurdles to market
Performing laparoscopy with cameras and monitors that have resolution 4 times that of HD could revolutionize visualization in the operating room, but 4K isn't yet commercially available for use in surgery. Manufacturers must figure a way to couple 4K camera heads onto endoscopes and make 4K video monitors that are small enough for the minimally invasive OR, and at a price that won't scare you away.

As one industry insider said, "Trying to hang a 50-inch screen on a boom is not going to happen." The goal for a 4K surgical display based on a 4- to 7-foot viewing distance, he says, is a 26-inch panel, but Dr. Palter says 4K lets you increase the size of the image on the screen without losing resolution. "You could put a 65-inch screen on the wall of the OR and still have better resolution than in your small little screen," he says. "You can scale the image dramatically."

Regardless of their size, 4K resolution monitor displays deliver an extremely high contrast ratio. Companies say this will aid surgeons by providing the ability to project truer levels of black, something that is critical to medical image quality for surgical and diagnostic applications.

A laparoscopic camera is about the size of a fist. The cameras Dr. Palter has used in his 4K procedures are considerably larger: "what you would see on a Hollywood set — 15-pound cameras that are a foot long."

Companies are moving quickly to bring 4K to the OR. Stryker Endoscopy is working on a 4K turnkey visualization "platform" that includes the camera head that houses the 4K sensors, the camera processing unit (console), the cabling and the monitor. Sony and Olympus have teamed up to develop endoscopes equipped with 3D and 4K technology. Sony's 3D imagery and 4K display technology will come aboard the endoscopes and other surgical tools manufactured by Olympus. Sony demonstrated the company's new 4K display technology as a work-in-progress technology preview for the medical industry at the recent American College of Surgeons Annual Clinical Congress.

If picture quality "unlike anything you've ever seen before" is more than you need, companies continue to advance and refine HD. EIZO and Stryker have announced their partnership to offer customers integrated large monitor management systems suitable for use in standard and hybrid operating rooms. As a result of this partnership, EIZO will provide large monitors that can display multiple video sources simultaneously in conjunction with Stryker integrated operating suites.

'Always another genration coming'
Could 4K ultra HD further revolutionize minimally invasive surgery as surgical facilities incorporate it into the OR of the future? "This is the inevitable leap of progress in technology, in endoscopy," says Dr. Palter. "There's always another generation coming."

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