SIGHT TO BEHOLD Vessels and other structures can be seen much more clearly with 4K technology.

Remember how you felt the first time you saw high-definition TV? How you knew you'd never be able to happily settle for your grainy tube set again? If you haven't seen 4K ultra high-definition yet, get ready for that same sensation.

"When people enter the room and see it, everybody's amazed," says Miroslav Uchal, MD, FACS, FASMBS, chief of bariatric surgery at St Vincent's Medical Center in Jacksonville, Fla., who recently trialed a new 4K system for the first time. "They're like, what is this? It's like a big wall with a perfect image."

Still on the fence about adding 4K to your ORs? "You don't really know what you're missing until you see it," says Peter Kung, MD, FAAOS, a partner at Longview (Wash.) Orthopedic Associates and chair of the Surgery Department at St. John's Medical Center in Longview. "You see the difference immediately."

Bigger and better
With nearly 4,000 pixels (as opposed to 1,080 for high definition and 480 with standard definition), the 4K picture isn't just much clearer, it can also be much larger, without losing definition. "I was amazed by how much magnification it gave me," says Dr. Uchal. "I put my instrument inside — a long grasper with a jaw that I know is 2 inches long — and I measured the image on the screen." The displayed jaw measured a crystal clear 29 inches, he says. "So that's nearly 15-full magnification. We used to be excited to get 10."

Another example: "My assistant put a finger through the incision," recalls Dr. Uchal. "So his glove was inside the belly and (on the screen) his finger was bigger than my arm. It's really amazing."

And the image stays sharp as you change location or settings, thanks to its sophisticated auto-focus feature. "When you want to zoom in, you don't have to move closer to the structure," says Dr. Uchal. "Or if you've pushed the length of the scope to its limit, there's no deterioration of the picture."

ROOM WITH A VIEW The 4K picture is so bright and sharp, there's no need to dim the OR lights.

The depth of field is extraordinary, adds Dr. Kung: "Things both near and far in your field of view remain in focus. You're looking at one giant picture and you can see everything, including what's close to the lens and what's farther away."

You don't need to darken the OR to take advantage of 4K's brilliant clarity. "I'm using ambient light with it in the OR," says Dr. Uchal. "The picture is so bright and sharp, I can have all the room lights on and still see everything fine." That, he says, helps reduce eyestrain. "The surgeon is bound to be more comfortable, because you see better in natural light." And unlike 3D systems, the 4K screens don't require special glasses.

Of course a camera that's technologically advanced must be bulkier and harder to manage, right? "It's exactly the same size as the regular high-def camera," says Dr. Kung, "It just uses a different lens and screen."

"Slick, small and sturdy" is how Dr. Uchal describes the camera. "And it has a very good locking mechanism. When you lock the telescope in, it stays put. It doesn't twist. The design is awesome."

Dr. Uchal's preferred setup involves using two screens: a 55-inch model for himself and a 32-inch screen for his assistant. "My experience is that bigger is better," he says. "If I go smaller, I feel claustrophobic and have to adjust. It's like driving a full-size sedan and then sitting in a small compact. It will get you where you need to go, but it's just not as comfortable."

But, he says, if the 55-inch screen is too big in some situations ("if anesthesia is complaining") the 32-inch model is still light-years ahead. "It gives me much, much better quality. I see detail, and if I see detail, I may avoid a critical blood vessel, or I may see the suture going through the bowel. You see every single detail. And you can be a safer surgeon if you see better."

But improved outcomes?
For now, surgeons like Drs. Uchal and Kung have to rely on the intuitive — some might say obvious — belief that better visualization will lead to better outcomes. "Is there a potential benefit? Sure," says Dr. Kung. And seeing has been converting for his fellow surgeons at St. John's Medical Center. "We basically use 4K for all our procedures," he says. "The urologists in our surgery center are using it now, as well." General surgeons at St. John's have also become believers, he says, adding, "The improved imaging might be even more helpful during their cases."

For Dr. Kung, the dramatically improved detail is especially helpful when he's performing challenging arthroscopic shoulder and knee repairs. "It's easier to see small details," he says. "Ultra high-def is really beneficial when the cartilage is still intact, but you're searching for small defects — looking to see where the cartilage is abnormal or a little softer, or where there's a tiny bubble in that area."

Dr. Kung also touts 4K for assessing blood vessels during procedures such as meniscus repairs. He adds, "You want to be able to judge healing potential and, if there's more vascularity, there's a higher healing potential. Its easier to see and appreciate that with a better camera."

Dr. Uchal performs roughly 500 weight-loss surgeries per year and, he says, there's no question that the newly acquired imaging technology is already making a big difference: "When I'm doing gastric bypass surgery, I see vessels and structures much more clearly.

For example, he says, the posterior of the abdominal wall is filled with branches of small vessels, which are difficult to identify and, when accidentally cut, fill the surrounding area will a small pool of blood. "It's not dangerous, but it slows you down," he adds. "With 4K, I'm able to see every single branch."

More to see
Is it just a matter of time before 4K becomes as standard in ORs as regular high definition is now? "I would think so," says Dr. Kung, "now that it's becoming more common and the price is becoming more reasonable. Once surgeons use it, they're going to want to continue using it."

Of course, as breathtakingly clear as the new technology is, it's only going to get better. Scientists and engineers are already working on bringing 8K to the OR. That's fine with Dr. Uchal, a self-described technology junkie. "I think we'll have 3D and 4K on curved screens in front of both the surgeon and the assistant in the next couple of years," he says. "We're getting there. Ultra high-def is definitely a step forward." OSM