SHARPER IMAGE Jason Dierking, MD, was thrilled when 4K imaging was added to the ORs at Buena Vista Regional Medical Center in Storm Lake, Iowa.

The gallbladder was gangrenous, bleeding, inflamed and draining pus. Brian Smith, MD, MSBS, FACS, a general surgeon at Physicians Regional Medical Center in Naples, Fla., didn't think there was any way he'd be able to see well enough to remove it laparoscopically. Luckily, Physicians Regional had recently upgraded its imaging technology to ultra high-definition video, the new frontier in laparoscopic and arthroscopic visualization. The challenging gallbladder resection was Dr. Smith's first surgery with the new system. He was able to avoid converting the case to an open procedure, thanks to the crystal clear images splashed across the OR's monitor, and quickly became sold on the imaging technology that's giving surgeons a glimpse at surgery's future.

The picture of safety
4K is short for four thousand, as in 4,000 pixels of horizontal resolution, a number that's 4 times greater than what you'd experience with full HD. That translates to a clearer picture with greater depth of field. On top of that, the color gamut (especially for reds and yellows) is heightened, meaning diagnostic decisions based on a tissue's shade can be made with greater confidence.

"Those factors make it easier to tell what I'm looking at on the monitor," says Dr. Smith. "It's easier to distinguish between normal and pathological anatomy, to identify structures that I need to target and to see through bloody fields."

This improved visualization means tiny branch vessels and capillaries can be identified and avoided altogether, or cauterized and clipped to stop bleeding. Previously, surgeons may have missed such things, bluntly dissecting through them. In other words, 4K allows for a more refined surgical approach.

The 5 mm scopes used with 4K imaging allow for smaller incisions (read: less chance of bleeding, infection and hernia) than the 10 mm scopes of the past. According to a study published in the Journal of Minimal Access Surgery, the rate of complication after conventional laparoscopic surgery is about 21 per 100,000 cases, and increases in proportion to the size of the port site incision (osmag.net/7tnybq).

"Our facility had imaging systems that needed to be updated," says Jason Dierking, MD, a general surgeon with Buena Vista Regional Medical Center in Storm Lake, Iowa. "We spent months trialing new technology, including 3D options. But the cameras aren't there yet. With 3D, we'd still have to use the 10 mm scopes, and we didn't want to take a step backward."

PICTURE PERFECT Surgeons who work with ultra high-definition imaging swear by the clinical benefits it provides.

Worth a closer look
Think of an older cell phone with a low pixel count. If you enlarge a photo on such a device, the image gets grainy. But on the most recent version of the iPhone, where the pixels-per-inch is greater, a picture can be blown up without sacrificing quality. It's the same with 4K imaging.

The higher resolution at a larger image size afforded by 4K means physicians can get a better picture with a bigger monitor (55 inches is recommended). This translates to greater visibility for everyone involved in a procedure. And because of the clarity of detail — 4K images don't blur the closer you get — there's more flexibility in terms of where a surgical team places the monitor. While most 55-inch HD monitors are wall mounted, 4K monitors can be placed on roll stands and ceiling booms that can be easily moved around the surgical field.

Images can be also cropped without sacrificing resolution on a 4K monitor, which can "tile" multiple images together. That's helpful if you'd like to see, for example, vital signs on the same screen as the surgical action. In integrated systems, live images can be wirelessly transmitted and viewed outside the OR. Pictures that are recorded can then be securely emailed to a patient, meaning information can be shared faster. And because 4K pictures are clearer, physicians have an easier time explaining to patients what they're seeing.

These systems allow for remote access, so if there are ever issues with the imaging process, product engineers can help from off site, meaning problems get solved quickly. But because the equipment is intuitive, the transition from HD to 4K should be seamless.

"This is one of the first times a big leap forward in surgical technology has resulted in something that's easier to use," says Dr. Smith. "Most of the time, when new devices are added, extensive training is needed. But not only have 4K manufacturers made imaging technology better, they've made it more user-friendly." Case in point, says Dr. Dierking: He can get the settings on his facility's imaging equipment calibrated for a specific type of surgery by pressing a single button.

Although outfitting your facility with 4K can be twice as expensive as adding HD, the enhanced imaging option is shaping up to be the next standard technology adoption. And with the potential it brings for ushering in a new era of surgical innovation, pioneering facilities realize the choice between HD and ultra high-def is clearer than a 4K image. OSM