The Inside Scoop on Surgical Video

We wanted to know if surgeons are liking what they’re seeing during surgery, so last month we asked readers for their thoughts on the imaging technologies used in their ORs. Most (81%) of the 104 survey respondents reported a large degree of surgeon satisfaction with their video monitors as well as excitement about the capabilities of emerging technologies such as 3D imaging, virtual reality (VR) and augmented reality (AR).

Physicians who work with 4K ultra-high-def imaging apparently love it, lauding how it leads to safer, quicker surgeries with better outcomes. “Our GI specialists say they can identify more polyps and cancers,” says Sean Floyd, RN, director of surgical services at TMC Bonham (Texas) Hospital. Adds Samir Shahin, RN, manager of perioperative services at NorthBay Healthcare in Fairfield, Calif., “Physicians are less likely to miss polyps and more likely to have cleaner screenings.”

There was much enthusiasm about the enhanced picture, color, sharpness and clarity — the “improved visualization” — that 4K provides. Lisa Seeds, RN, BSN, night supervisor of the main OR at Bon Secours St. Mary’s Hospital in Richmond, Va., says surgeons who have been using 4K monitors in the hospital’s two ORs believe the imaging systems provide a better view of the surgical cavity, making for more precise movement and technique.

“Right now, 4K is being requested for better visualization and clarity with robotic and laparoscopic cases,” says James Wade, BSN, RN, CNOR, assistant nurse manager at Legacy Health Salmon Creek in Vancouver, Wash.

“Surgeons are using 4K at other facilities and feel it makes a difference.”

However, some respondents reported that true 4K remains elusive because their entire video chain hasn’t yet been upgraded. “Our monitor does not have the specific camera or cables for 4K, so it doesn’t make much of a difference,” says one surgery coordinator.

Other advanced imaging technologies such as 3D, VR and AR are largely still not in use. Not surprisingly, cost is a major inhibitor of a movement toward adding them. “We are not currently using any of these,” says one reader.

“For our independent physicians group, the benefits would need to outweigh the additional costs and upkeep. Our surgeons may feel differently if given the option to use them in a hospital setting.”

We also inquired about difficulties or frustrations readers had with their surgical monitors. Many had no complaints. Some simply lamented the age of their screens and the damage they’ve sustained from heavy everyday use. Others mentioned positioning issues in the OR due to limited floor space, cable clutter, and difficulties with ceiling and wall mounting, which speaks more to the layouts of their facilities and quality of their video integration than the screens themselves. Several respondents were eager to upgrade to 4K video when it would be financially feasible for their facilities to do so. Some spoke of a desire for better video clarity, color, depth, or to add additional or larger screens.

Readers were invited to be as creative as they’d like and imagine any type of surgical screen for their center. What would it be used to do? One wanted a “screen that would allow everyone to see the same thing, with clarity and connectivity that is so simple a first-grader could use it.” A clinical director wished for a split-screen with endoscope video on one side and the sinus navigation screen on the other to make it easier for her surgeons to operate.

Several respondents wanted monitors with more wireless capability and ease of movement to make things easier for surgeons. Others wanted more touchscreens, more integration with OR equipment and computer systems, access to charts and the internet, and additional monitors in ORs or at the main desk to display cases and status. Other wishlist items include picture-in-picture settings, the ability to take snapshots of video images and the capability to view C-arm images or flip between patient info and X-rays.

Respondents were asked to give other facility leaders advice for investing in new video platforms. “Go as advanced as possible at the time of purchase,” says Mr. Wade. “Technology changes so quickly that you can be behind [the technology curve] at the time of purchase and limit yourself.”

Another facility director had similar advice, imploring you to commit to modern technology. Indeed, a recurring theme was to not “go cheap” and instead invest in reliable, durable, high-quality equipment.

Still, others cautioned against defaulting to top-of-the-line products with unneeded bells and whistles. “Don’t spend time looking for monitors that have too many frills if they’re being used for viewing only,” says a nurse. “Purchase the fancy monitors for specific purposes.”

Respondents advise taking your time and trialing as many brands as possible during the research and evaluation process. “Do your due diligence and have a good understanding of how the technology works,” says Geraldine Clark-Hall, RN, BSN, MSN, DNP, CNOR, CSSM, director at Kaiser Permanente Hospital Woodland Hills (Calif.).

It’s also essential to assess a vendor’s level of technical support and see imaging technology in action. “Visit facilities that have monitors mounted on booms or arms,” says Amber Kling, BSN, RN, CNOR, ONC, operating room manager at Kansas City Orthopaedic Institute in Leawood, Kan.

“I would have mounted our monitors now, looking back.”

Indeed, being able to easily adjust the position of monitors around the OR table is a key consideration for many surgeons who understand the importance of ergonomic OR set-ups. “Static injury to the neck and shoulders is something real and rarely considered when assessing the features of a screen,” says Joseph Gauta, MD, president of Surgery Center of Naples (Fla.).

Many respondents suggest making sure surgeons are involved in the trialing and purchasing decisions, as well as in determining the locations of the monitors, so the products truly suit their needs. Others suggest including anesthesia, nurses and techs in the process to account for their specific needs and requirements, including making sure you select the optimal screen size. Larger monitors have hit the market in recent years, and it appears facilities are beginning to transition to big screen surgery; 20% of the respondent reports they have a monitor of 51 inches or larger in their ORs.

One facility leader believes surgeon decisiveness is more important than surgeon preference. “I would like them all to decide on one imaging system — and I don’t care which one,” says Jackie Crowder, CNO at St. Joseph’s Outpatient Surgery Center in Phoenix.

“I’ve been doing this a long time, and I am not holding my breath.”

The stunning views of surgery afforded by the latest screens and platforms might push them to act sooner. As one perioperative services director says, “Be ready to buy after your surgeons try, because they won’t be satisfied with their current equipment.” OSM