Surgery's Feature Presentation

Surgical Video and Imaging

By: Daniel Cook

Published: 5/15/2020

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The benefits of big screen 4K imaging go well beyond the initial wow factor.


Walk into an OR where 4K video is showing on flat screen monitors and try not to gawk. "The quality of the video images displayed in today's ORs are remarkable," says Christopher Schlachta, MD, a professor in the departments of surgery and oncology at the Schulich School of Medicine and Dentistry at Western University in London, Ontario.

Ultra-high-definition imaging is truly a sight to behold, but the benefits of big screen surgery go well beyond the initial wow factor. 4K monitors also allow for greater depth of color and depth perception, two key factors in helping surgeons perform intricate laparoscopic procedures. "We need to maintain instrument triangulation, accurately judge the depth of field and distances between anatomical landmarks or anatomy and our instruments," says Dr. Schlachta. The higher the resolution, the higher the color depth and the better the contrast and shading — the visual clues surgeons use to see clearer and easier.

Dr. Schlachta points out 4K video can be displayed on bigger monitors without the image quality degrading, letting surgeons zoom in on specific anatomy tissue without losing an ounce of clarity. Some large monitors come with tiling functions or split-screen functionality, letting surgical teams call up secondary displays such as MRI images without impacting the surgeon's view of the surgical display.

Gone are the days of stacking monitors on top of video towers and forcing surgeons to crane their necks in ergonomically incorrect positions to perform surgery. Large monitors can be mounted on carts and positioned farther away from the sterile field to free up space around the OR table, letting surgeons move freely and position themselves in ergonomic friendly positions.

"Place monitors throughout the OR with flow and function in mind," says Keith W. Mignault, MSBE, senior equipment planner at IMEG Corp., in Naperville, Ill. He says OR equipment should let staff move around safely and efficiently.

He suggests saving money by hanging standard definition versions on the outer walls of the OR and installing 4K monitors around the sterile field on booms or carts. "Surgeons and staff should be able to easily position the screens so they can view the images they want, where and when they want them," says Mr. Mignault. "That will help the case to go faster and smoother."

From chip to screen

CURRENT VIEW State-of-the-state ORs are outfitted to support 4K imaging, according to Keith W. Mignault, MSBE, senior equipment planner at IMEG Corp.

The near true-to-life 4K ultra-high-definition resolution is achieved via computer-generated images captured by a camera chip, broken down into bits and bytes, and reassembled for display on a monitor. Imaging systems can't turn a low-quality image into a high-quality image, but they can degrade image quality. "The goal is to preserve the high-quality original and show it in the best way possible," says Mr. Mignault.

Ultra-high-definition signals send video signals with more digital information than standard HD to video monitors, which use the information to display images in greater detail. "The trained eye of surgeons is able to notice the subtle differences of the transitional lines between the intestine and the lining of the walls," says Mr. Mignault. "The more detail in the video image, the better those transitional lines show up."

"I expect surgery performed in 4K will be safer and more efficient, which will lead to better outcomes."
— Christopher Schlachta, MD

He says it's important to differentiate between true ultra-high-def systems and systems that claim to be 4K, but upscale four 1080p signals to match 4K's high-end image quality. The entire imaging chain, from camera to monitor, must support the bandwidth of true 4K. If you plan to route video to monitors throughout the OR to keep the entire surgical team in the loop of the current phase of surgery, make sure the routing system has enough imaging bandwidth to transmit 4K signals.

The positioning of monitors also impacts angular resolution, which is essentially the distance your surgeon should stand from video monitors to realize their full imaging capabilities. Doubling the size of a 4K monitor will not impact picture resolution, "I can look at a 4K monitor that is four times the size of a standard definition monitor from farther away, beyond my eye's ability to detect individual pixels, and still see great detail in the image," says Dr. Schlachta.

Looking ahead

Surgical imaging continues to advance with 8K video resolution beginning to enter the consumer market, but your ultra-high-def screens won't need to be replaced anytime soon, according to Mr. Mignault.

He believes the more immediate trend in surgery will involve ensuring 4K video technology interrelates with a wide range of device manufacturers. "The goal is to make 4K better," says Mr. Mignault. "I don't believe 8K will be a significant trend for quite some time."

It's fair to wonder how much more the stunning current views of surgery can improve. The clinical benefits of 4K have yet to be proven in clinical trials, but surgeons who operate using the imaging technology trust what their eyes tell them. "I expect surgery performed in 4K is safer and more efficient, which will lead to better outcomes," says Dr. Schlachta. OSM

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