OR Screen Size Matters, But There's More

Surgical Video and Imaging

By: Jared Bilski

Published: 5/16/2019

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A monitor's diagonal length is important, but not everything is measured in inches.


Surgeons sometimes obsess over screen size, so fixated on a monitor's diagonal length that they overlook the 3 P's: positioning, proximity and pixels. Yes, size is important, but not as important as your physicians might have you believe.

Unless you're doing extremely complex procedures like neurosurgery, you don't need a giant 65-inch 4K wall monitor. Plus, unless you're outfitting for a futuristic hybrid OR, you're dealing with standardized screen sizes to begin with, says Suraj S. Soudagar, MS, MBA, LEED AP, associate principal and project executive with IMEG Corp., a healthcare engineering firm in Naperville, Ill.

For wall monitors, most vendors offer screens between 50 inches and 58 inches. There are some 60-inch surgical monitors out there, but not many.

As a rule-of-thumb, surgical planners say wall-mounted OR monitors are nearly twice as large as the screens suspended from booms or sitting on carts in the surgical field. The range inside the field varies depending on image quality. Most HD monitors today are 26 inches, which is up from the 20- to 24-inch HD monitors that dominated the market just 5 years ago, says Mr. Soudagar.

Most 4K monitors are 32 inches, though there are some decent quality 30-inch 4K monitors, says Mr. Soudagar. And 32 inches is the largest screen size you're likely to see in the surgical field for a very simple reason. "It's the maximum weight that can be borne by the arms that hold up the monitors in the surgical field," says Mr. Soudagar. With the creation of lighter monitor panels, we may see the surgical field displays going up to 36 inches — "but that is unlikely any time soon," adds Mr. Soudagar.

Another consideration is space. Most ORs are already crammed with equipment. Jumping from a 26-inch HD monitor to a 32-inch 4K screen might not seem like much, but when you're talking about already cramped quarters with precious little free space, that small amount can impact the flow during surgery, says an expert in integrated workflow solutions. Even minor increases in screen size can take your surgeons and staff some getting used to, he says.

Placement is paramount

RULE OF 2 For all minimally invasive procedures, there should be a minimum of 2 monitors so staff on either side of the bed have an unobstructed line of vision without having to contort their necks.   |  St. Vincent's HealthCare

Some argue that screen placement matters more than screen size. If you have surgeons who are cranking out 4 to 6 cases per day, fatigue will set in more quickly if the monitors aren't optimally placed.

"I easily spend 12 hours in the OR on certain days, and with good monitors set up correctly for my needs, I don't feel tired and the quality goes up," says Miroslav Uchal, MD, FACS, FASMBC, director of bariatric surgery at St. Vincent's Medical Center in Jacksonville, Fla.

What does proper OR placement look like? The viewing guidelines (osmag.net/8zCVsK) we rely on for at-home TV viewing generally hold true in the OR as well. Surgical equipment planners recommend placing wall monitors at the foot of the bed and around 8 to 10 feet away from the viewer. In the surgical field, viewing should be done at around 3 to 5 feet from the screen, at 10 to 25 degrees below the line of sight and in front of the viewer.

"I hate that living room style where the screen is up above the fireplace. That's where wall monitors tend to be set in the OR. I prefer the screen to be slightly below my eye level," says Dr. Uchal. "I set the height and angle of the monitors myself."

And for the surgical field, Dr. Uchal has 2 monitors attached to towers and adjusted to his specifications that get wheeled in for him when he's working in a different OR. He sees OR screens in the same light as all other surgical equipment and offers the following advice to administrators: Buy and set up the equipment how your surgeons want it. With instruments, some surgeons prefer pistol grip while others prefer in-line. You can't force a surgeon to use something he really doesn't want to use. That goes for your screens, too. "When it comes to your monitors, those flat corporate purchases for each and every OR simply don't work," says Dr. Uchal.

Neutral position

Regardless of the size of your monitors, mounting or suspending them "in a neutral position relative to the viewer's eyes" is critical not only for efficiency and productivity, but also for preventing musculoskeletal injuries, according to AORN's "Guideline for Safe Patient Handling and Movement" (osmag.net/Sz2AhB). A neutral position means the height will varying according to the height of the OR team member viewing the monitor.

Misplaced monitors can result in scrubbed perioperative team members experiencing static neck flexion, extension and rotation ranging from physical discomfort — such as fatigue and neck strain — to musculoskeletal injury, says Mary J. Ogg, MSN, RN, CNOR, a senior perioperative practice specialist with AORN.

Remember the "Rule of 2," adds Ms. Ogg. Just as a poorly positioned monitor can increase the chances of injury, so too can using only a single monitor. For all minimally invasive procedures, there should be a minimum of 2 monitors. This gives team members on each side of the OR bed an unobstructed line of vision without twisting or turning their necks, says Ms. Ogg.

HD or 4K?

You'll find no shortage of vendors and experts praising the quality of 4K monitors, but if you've been satisfied with HD is there really any urgency to switch to 4K? Probably not — especially if the source you're using to route images and videos through is still in HD. After all, it doesn't make sense to have a high-end monitor with a low-end source.

"4K is driven by source and not monitor," says Mr. Soudagar. "If your source is HD and it can scale up to 4K, then you're fine with an HD monitor. If, however, your source is already in 4K, then it makes more sense to go down the 4K path."

Specialty plays a role, too. For orthopedic cases, where surgeons are mainly looking at fluoroscopy images, you don't need 4K. But if you're doing robotics or laparoscopic procedures where the endoscopy equipment is in 4K, you'll want a compatible video monitor.

"It's all about the granularity of the image," says Mr. Soudagar. "That granularity really showcases the differences in tissue color. It makes those whites, yellows and off-whites really pop." No matter the screen size. OSM