Surgery on the Big Screen


Large monitors displaying brilliant ultra-high-def images are transforming surgical care.

Cohen Children’s Medical Center in New Hyde Park, N.Y., recently opened the Pediatric Surgical Operating Complex, a $110 million, 24,000-square-foot, state-of-the-art facility where surgeons perform cardiothoracic, neurologic, orthopedic and general surgery procedures. It’s a culmination of the medical center’s goal of providing cutting-edge, comprehensive care for neonates, infants and children. Jose Prince, MD, surgeon-in-chief at Cohen Children’s, appreciates the bright color schemes and stunning photo walls in each of the facility’s eight ORs, but it’s the ultra-high-definition images displayed on two large wall-mounted monitors and screens hung around the sterile field that catch his eye.

“We can route different types of information to the screens at the same time,” says Dr. Prince. For example, the patient’s vital signs can be shown on one monitor and pre-op X-rays or CT scans on another so surgeons, anesthesia providers and members of the surgical team can monitor the information throughout the case. The monitors hang on booms around the sterile field and can be positioned to enhance the ergonomic comfort of surgeons during complicated and lengthy cases.

SUITE LOOK Dr. Jose Prince (second from left) prepares to perform surgery in the new Pediatric Surgical Operating Complex at Cohen Children’s Medical Center.   |  Northwell Health

Dr. Prince particularly appreciates being able to view multiple images during the complex hybrid cases he performs. He says being able to see images captured by a laparoscope, an endoscope and a bronchoscope on separate monitors or embedded onto the large screen in the room provides him with the information he needs to perform safer and more effective surgery. Even the overhead surgical lights contain in-line cameras, which capture images of open surgery and project them to the room’s monitors. “Improving the line of sight during the complex procedures I perform is a great advancement in patient care,” says Dr. Prince.

The ability to zoom in tightly on anatomy and magnify the images without losing an ounce of clarity while operating with ultra-high-definition video is vitally important for any surgeon, but perhaps more so for Dr. Prince. He routinely performs procedures on neonates who are sometimes smaller than the instrumentation he’s using. “There’s so much less guessing,” he says. “You’re able to see exactly where the point is that you need to go.”

Advanced video imaging and large monitors can enhance outcomes, according to Dr. Prince. “The light, scale and clarity of the images help us develop new and safer approaches to performing dissections in children,” says Dr. Prince. “That’s part of what we hope this technology allows us to continue doing moving forward.”

Displaying surgical images on multiple monitors around the OR improves coordination and collaboration among members of the surgical team. “Gone are the days of them staring at the back of my head, unable to determine the next step of the procedure,” he says. “Nurses, techs and anesthesia providers can now follow along and anticipate the next step in the case and be ready to help immediately if we encounter difficulties.”

The integrated ORs at the Pediatric Surgical Operating Complex are wired to route video images seamlessly to the numerous monitors in the room or to external locations, including medical schools, education conferences and expert surgeons throughout the country or around the world — key considerations for receiving advice on difficult cases or educating the next generation of surgical providers. After surgery, Dr. Prince can send captured video images to create and develop a catalogue of his procedures, which he can use to train future surgeons, review his own procedures to remind himself how they were performed or look for small ways to improve his technique or file away rare or unique cases he likely won’t experience again during his career. “That’s another strength of the technology we hope to develop over time,” says Dr. Prince. “Being able to develop a video library over time that will be useful to share information with other providers and myself. I think that’s another strength we hope to develop over time.

“OR integration has created new channels and new ways for us to communicate, which is so important in health care,” says Dr. Prince. “The new rooms are the culmination of so many people’s dreams. They’re where we work to save and protect the dreams of our patients and their families as we teach surgery to the next generation of pediatric surgeons. This facility has boosted the entire team. It matched the culture and spirit of what it feels like to take care of children.“

Advanced imaging technology is making more minimally invasive surgery possible, according to Iyoob Ilyas, MD, a board-certified general and colorectal surgeon at Eisenhower Health in Rancho Mirage, Calif. Smaller incisions lead to what Dr. Ilyas calls “patient-friendly” surgery, a term he uses to describe procedures that lower risk of complications, including blood loss, pain and slow recoveries.

Open procedures provide surgeons with direct views of critical structures, but Dr. Ilyas believes ultra-high-def imaging used during minimally invasive surgery gives him the best views of anatomy. “I’m able to work with enlarged images — 10 to 20 times magnification — that allow me to access critical areas without making large incisions, a development that translates into better outcomes for patients,” he says.

During open colon operations, for example, Dr. Ilyas must dissect down to the ureter to truly identify the structure. When performing laparoscopic surgery with ultra-high-def, he can use immunofluorescence — which involves using indocyanine green (ICG) dye as a contrasting agent — in real time to identify arterial blood flow and improve visualization of the ureter. Injecting ICG into the patient during surgery allows him to notice when he’s approaching the ureter and adjust course as needed. “I’m more cautious during complicated cases involving a great deal of tissue inflammation or cancer cells in the area,” says Dr. Ilyas.

ICG also allows Dr. Ilyas to determine the viability of specific tissue, a key consideration during the reconstruction phase of colon surgery to ensure continuity of the organ is maintained. “I need to know that I’m connecting viable tissue to other viable tissue,” he explains. “The dye provides objective evidence that the bowel is well perfused.”

Seeing surgery on the big screen is an eye-opening experience, but hard data supporting the use of the technology is currently lacking. That doesn’t mean facilities that provide advanced surgical care should ignore the importance of providing surgeons and surgical teams with access to the most advanced video capabilities available, especially if it has the potential to improve patient care. “Clinical evidence of benefit normally lags behind the development and emergence of new,” says Dr. Ilyas. “But you don’t have to convince a surgeon who uses the latest imaging platforms about the advantages they provide.” OSM

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