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Thinking of Buying... 4K Camera Systems

By: Suraj Soudagar

Published: 12/19/2019

There's a lot to consider before upgrading your OR imaging systems.

You can buy all the 4K surgical monitors you want, but unless you have a 4K surgical camera feeding them images, along with a 4K-capable camera control unit and a networking infrastructure with enough bandwidth, you're not actually seeing real-time 4K video. Numerous vendors offer a variety of end-to-end 4K surgical camera systems. From Arthrex to Zimmer Biomet, check out 11 product snapshots beginning on page 79.

The adoption rate for 4K surgical cameras has been slow, as administrators and executives need a lot of convincing that this upgrade is actually needed, clinically necessary and cost-justifiable. The movement from ancient standard-def to HD was much quicker because it was a quantum leap in terms of clarity, obvious to virtually anyone. The difference between HD and 4K is undeniable theoretically, but is more subtle to the human eye. So the sense of urgency to upgrade isn't quite the same, although we're now seeing 4K gain some traction in ORs. Some things to consider:

Do you really need this yet? 4K is objectively superior to HD; it's 4 times the amount of pixels, providing much richer detail. But does your facility actually need 4K? 4K camera systems are much more expensive right now than HD camera systems, at about a 40% to 50% premium — although that will likely change a few years out. Also remember, you're not just buying a 4K camera system; you might also need to spend on upgrades to your network infrastructure and storage capabilities.

It goes beyond cost justification, though. Some surgeons are totally happy with HD; others really can't tell the difference between HD and 4K. Bottom line: 4K is undoubtedly great, and it's absolutely going to be commonplace eventually in ORs of all types. Your task is to determine why, and when, you really need it. If you can justify the cost, by all means, go for it, because the technology is awesome.

4K SURGERY Ultra-high-def imaging displays brighter, clearer, more detailed images of small vessels, tissues and organs.

Advantages beyond resolution. Higher resolution is great, but what does it mean in practice? As we mentioned, at first glance the naked eye might not be able to tell much difference between HD and 4K. But 4K has some secret sauce that makes it compelling. For one, when the surgeon zooms in on a 4K image using a camera feature like optical zoom, it won't pixelate like an HD image might. Second, 4K offers a wider color gamut than HD does, which helps surgeons distinguish finer patterns and structures of tissue when they're enlarged. A red is a red to me, but light red versus dark red might be a major distinction for the surgeon. Third, individual pixels are not discernable when you display images on a large screen that's positioned close to the surgeon. In addition, 4K video looks better the larger the screen gets because there's less space between the pixels, so if you have a wall-mounted 55-inch 4K monitor, the images will appear much sharper than they would if the signal and monitor were HD.
Surgeon input. Some of your surgeons may be championing a 4K upgrade, which is good, because as an administrator you're going to need their help to push this over the goal line. But also consider this: Many surgeons don't like to introduce changes to their routines if they can avoid it. They might be totally happy with their HD systems and see no reason to upgrade. Ask your surgeons how they feel about 4K — especially your big hitters.
Recruiting. If you're looking to recruit top surgeons, 4K will be a big draw. Your facility will also be more attractive to young surgeons who trained on 4K as students.
Upgrade all of your ORs — not some. It might be tempting to dip your toe by upgrading 1 or 2 ORs to 4K and leaving the rest with HD. The problem with that is once surgeons see the 4K or hear raves about it from other surgeons, they're probably going to want it, too. That could lead to more demand for the 4K ORs and underutilization of the HD ORs. For this upgrade to work best, it should be all or nothing, but budgets do play a role. That also goes for individual 4K systems — buy all of the components of the system, not just the camera, not just the monitor. It makes little sense to do this piecemeal, because if the entire image processing chain isn't 4K, you're not seeing 4K.
Servers and storage. Your surgeons will generate a lot of 4K video and images. How will you collect, store, manage and share these files? Some camera vendors offer their own servers, while some offer connections to your existing PACS system. How long will you need to store images and video? Some systems are "first in, first out," meaning that when the server fills up, it starts to delete the oldest content. How do these 4K "endoimages" fit into your facility's larger image management policies and procedures? These are extremely "heavy" files compared to HD; do you have enough storage space to hold them all today, or in a year? Also consider who needs access to the files and where they need access. Do your surgeons want to be able to put files on a flash drive and examine them at home? Can this content be accessed remotely over a VPN or the internet? Find out.
Network infrastructure. This goes hand in hand with storage. 4K images and video require a ton of bandwidth to travel from one place to another, both inside and outside the OR. Your existing networking infrastructure might not be able to carry this load. If you're using Ethernet cables, you should upgrade to fiber. Now, there are ways to mitigate this problem. Some OR integration vendors compress images at the source and then uncompress them at the destination to save on bandwidth usage. Bottom line, you'll need to match your infrastructure to the 4K input and output sources, otherwise there will be a delay between the time you click on an image and when the image pops up on your screen. If you're buying a 4K visualization tower where all of the components of the camera system are integrated, you won't have as much of a problem in the OR because everything is directly connected to the output of the cameras. But if you're sending these files outside the OR, you'll need the bandwidth required to do so.
Autoclavability. Some 4K camera heads can't go through the washer cycle and must be hand-washed with hydrogen peroxide or another agent. But many camera heads are autoclavable, so they can undergo a more stringent sterilization process and you don't need to worry as much about SSIs.
Light source. Most camera heads are paired with a xenon or LED light source. LED is the more modern choice, offering longer life and finer control of color temperature. Still, some surgeons who have used xenon for a long time prefer it.
Control. The most basic mechanisms for controlling the camera are hard buttons on the camera head. I've found surgeons prefer having this immediate and total control. But we're now seeing other methods of control emerge, such as remote controls and tablet apps. Having an attendant control the camera via an app might be a good-to-have feature, but keep in mind that most surgeons want absolute and full control over the camera.
Presets. Some systems offer the ability to preprogram specific image and video settings for different surgeons or procedures. This can be very helpful in reducing turnaround times and maximizing OR utilization.
Trial. Have your surgeon 4K champion(s) spend a month or so with each camera system so they can evaluate the optics and other features. You won't be able to determine yourself how a surgeon really looks at a particular tissue or anatomy, or what color rendering he likes best. It's all in the eyes of the ultimate beholder: the surgeon. If you purchase a system they don't like, they won't use it.OSM

$Arthre\x$

Arthrex

Synergy UHD4

synergy.arthrex.com
800-933-7001

FYI: Arthrex, which boasts of being first to market with 4K surgical resolution in 2015, offers its 4K endoscopic camera as part of a streamlined system, combining it with LED lighting, image management and network integration, all controlled by a tablet. The camera head, housed in hermetically sealed titanium, is autoclavable and its buttons are customizable, while the image management system directly uploads still images and video to the patient's chart.

$Conm\ed$

Conmed

4K Ultra-High Definition Visualization System

conmed.com
800-448-6506

FYI: This system, built for multiple specialties, is designed to be an "all-in-one" purchase. Included are autoclavable camera heads, a camera controller, a 31-inch Sony 4K monitor, a Sony medical-grade full-page digital color printer, a cart with 5 adjustable shelves, a direct LED light source, laparoscopes and arthroscopes, customizable user profiles, integrated data security, a content management system with multi-channel HD recording, and wireless (or wired) integration with EMR and PACS systems. The camera heads come with a 5-year warranty against autoclave damage.

$E\izo$

Eizo

CuratOR SC430-PTR

eizo.com
800-800-5202 x200

FYI: This system features an integrated triaxial mount — pan, tilt and roll, all in one — for more versatile positioning. To avoid obstructions and shadows from the surgeon's body, you can attach the camera to designated ceiling arms. Its 30x optical zoom lets you focus on extremely narrow target areas while avoiding pixelization and maintaining smooth, clear 4K resolution. The camera also captures audio, which it syncs with the video, enabling clinicians reviewing the footage to both hear and see the surgery. Control is provided through buttons on the front panel of the camera control unit, via Eizo's OR software, and via an optional wired remote control; both the panel and remote feature a joystick. The camera connects to its control unit through a single cable that supplies audio, video and power.

$Karl Storz Endos\copy$

Karl Storz Endoscopy

IMAGE1 S 4U One-Chip 4K UHD Camera Head (TH120)

karlstorz.com
800-421-0837

FYI: This new 4K camera head benefits from its parent system's modularity. The IMAGE1 S camera platform was introduced in 2014, but if you already have it you can easily integrate the TH120 with your existing system, and it will be automatically compatible with existing features such as flexible/rigid, fluorescence and 3D endoscopy. The TH120 offers 3 visualization technologies for tissue differentiation: homogeneous illumination, contrast enhancement, and spectral color shift and switch. IMAGE1 S users can still use their older non-4K camera heads, so there's really no waste here.

$Med X C\hange$

Med X Change

4Klear

medxchange.com/4klear-all-in-one-camera-recorder
941-794-9977

FYI: This is 2 products in 1: a medical grade 4K surgical microscope camera combined with a 4K recorder and still capture. An integrated 5-inch touchscreen provides both camera and recorder controls. Settings can account for physician preferences. In addition to DICOM integration options, as well as a documented API for system integrators, 4Klear also can stream live video over an IP network, while the company's ?iOS app provides encrypted wireless control. By using a 1???2-inch 4K60hz CMOS chip, the company claims 4Klear delivers a wider field of view compared to cameras with traditional 1???3-inch chips. Note that this camera is specifically designed for use with surgical microscopes — it's not an autoclavable or endoscopic camera, as it's not 510(K)-cleared.

$Nov\aProbe$

NovaProbe

UHDCAM 4K

novaprobe.com
215-259-3673

FYI: This U.S.-made product is touted as the world's first fully embedded touch-enabled 4K endoscopic camera system. The company says touch is more efficient for capture and visualization control compared to the physical buttons on other cameras, letting the surgeon focus more on the surgery itself. The touch interface can be used to set brightness, contrast, saturation, sharpness, frame rate and other parameters; the system also includes automatic and manual white balance, which the company claims is a unique feature. The waterproof camera offers 4k optical zoom — an actual lens adjustment — compared to less accurate digital zoom image processing software. By combining the camera, console and monitor, the company says it offers a smaller footprint than many other camera systems.

$\Olympus$

Olympus

ORBEYE

medical.olympusamerica.com/products/orbeye
800-401-1086

FYI: What about 4K and 3D images in one package? A joint venture between Sony and Olympus, this "video microscope" or "exoscope" works with a 55-inch 4K/3D monitor that can magnify anatomical features to provide more visual information, not just to the surgeon but to the entire surgical team. From an ergonomics perspective, it's easier on the surgeon's neck, as he's not peering through loupes for hours on end. Used in conjunction with Olympus's 3D ENDOEYE Flex, ORBEYE is approximately 50% lighter and 95% smaller in volume above the surgical field than Olympus's previous model, freeing up surgical space, shortening setup times, allowing for easier positioning and enabling easier transport between ORs. Olympus claims zero image latency for smoother viewing and manipulation of the target location.

$Richard Wolf Medical Ins\truments$

Richard Wolf Medical Instruments

ENDOCAM Logic 4K

4k.richard-wolf.com
800-323-9653

FYI: This system is notable for its 6 optional Special Imaging Modes — digital image processing algorithms intended to help render structures that are difficult to discern more clearly. Each mode can be switched on and off at the touch of a button on the camera head. The system is compatible with all user components and camera heads of the previous ENDOCAM Logic HD system, as well as with Richard Wolf's core nova OR integration system. Images and videos are stored via USB. The company says the lightweight camera head is designed to reduce hand fatigue during endoscopic procedures.

$Smi\th+Nephew$

Smith+Nephew

LENS 4K Surgical Imaging System

smith-nephew.com
800-343-5717

FYI: This camera head is paired with a camera control unit with integrated light source, image management options and an iPad app for remote control as well as programmable control buttons on the camera head. The company touts the autoclavable camera head's balance and comfort in the surgeon's hand, as well as proprietary 4K real-time image processing it says reduces flare and enhances depth of field. Images and video can be transferred to the patient's third-party EMR as well as PACS, and reports can be created and shared.

Stryker

1688 Advanced Imaging Modalities (AIM) 4K Platform

1688aim4k.com
408-754-2000

FYI: This 4K camera system, intended for procedures like arthroscopy, laparoscopy, urology, gynecology, colorectal and ENT, adds a big enhancement to 4K images — fluorescence, which enhances real-time imaging of perfusion, blood flow and biliary anatomy through contrasting colors. Another interesting feature is proprietary auto-light technology, which automatically corrects poor lighting in difficult-to-see posterior compartments and self-adjusts based on anatomy, like the back of the knee or bottom of the shoulder. Every mode and setting is controllable via buttons on the camera head. The comprehensive imaging system includes the camera heads and control unit, a compact OR cart, a printer and even an insufflator for inflow/outflow management with heated, humidified, and smoke evacuation. The camera system integrates with Stryker's Connected OR Hub software for capturing, recording, streaming and printing images, and is customizable for surgeon preferences.

$Zi\mmer Biomet$

Zimmer Biomet

ZEOS (Zimmer Biomet Endoscopic Optical System)

zimmerbiomet.com/surgical
800-830-0970

FYI: This system, designed for endoscopic procedures like orthopedics, ENT, GI, urology and abdominal surgery, features an autoclavable 4K camera head, a wireless tablet that provides access to camera controls, physician preferences, and settings for specific surgical specialties, and a camera control unit. Its DICOM (Digital Imaging and Communications in Medicine)-compatibility provides nurses a dropdown menu for "today's cases" on the tablet, as opposed to them needing to load patient information before every case. The camera head comes with 4 programmable buttons that control the LED light source, image management functionality and video settings, while the control provides an LED light source, 4K UHD image processor and an image and video capture device.