Laparoscopic Imaging Advances

Improvements allow surgeons to see anatomy in greater detail to maximize safety and efficiency.

I may be aging myself, but I trained in an era that was all laparoscopy and endoscopy; there was no robotics at the time. I love minimally invasive surgery (MIS) and at the time of my training, I felt like MIS had a strong future in the colorectal specialty.

While robotic surgery is the newer, flashier technology on the market, laparoscopic imaging advances are happening — perhaps with a little less fanfare than robotics. For smaller ASCs, these laparoscopic imaging advances take a smaller bite out of the budget while still delivering safe, reliable surgical outcomes.

Seeing clearly

Years ago, high definition (HD) was all the rage. But technology is advancing so rapidly that, in the operating room, HD is now actually considered low resolution. 4K is now the baseline resolution we aim for anytime we build out or install systems. 4K provides enhanced color, sharpness and clarity that offers surgeons visualization advantages without the multimillion-dollar price tag that comes with a robotic platform.

The potential of 3D imaging has always been of interest, but it hasn’t exactly taken off yet. It was very gimmicky when it was first demoed. The cameras were larger, the optics were not as clear, and the technology required the surgeon to wear 3D goggles that were usually inconvenient and, depending upon the axis by which they looked to, the screen would change the optical resolution. Some companies are still developing 3D imaging technology, but many surgeons who are interested in 3D moved over to the robotics space.

Pieces of the puzzle

I CAN SEE CLEARLY NOW The clarity, image size and image density of laparoscopic images have all improved.

The camera head is a key piece of the broader imaging puzzle. With laparoscopy equipment, you have the camera head that you hold in your hand, and then you attach a detachable lens to it — just like you would a camera.

There are different angles and different shapes of lenses, like a 30-degree down (urologists like to use a 45- or 70-degree lens depending on the view they need). The image clarity is dictated by the quality of the lens as well as the camera head in your hand. That camera head acts like a processor, shooting all the images to a computer in the room that digitally enhances the images and creates image overlays. A cable connects the lens to the processor. Some of those processors now feature an embedded light source, while others require you to plug into an external one. The video processor is placed in the back of the room, where it acts like a centralized command center. It places CT scans on monitors and is able to manipulate things for us. Some of the newer processors also offer video recording and broadcasting for teaching purposes.

If you are looking to upgrade your laparoscopy equipment, the first thing I would start with is a new camera head and new lenses. These imaging upgrades will eventually require a new computer processor system, but you can usually get away with staggering the update on your monitors.

One thing administrators need to seriously consider when making upgrades to their ORs is how these changes will effect a surgeon’s ergonomics. With laparoscopy, the surgeon is accessing a patient’s anatomy through a straw in a straight instrument, and that’s how it has always been. Recently, a few companies have developed wristed instruments using laparoscopy that mimics robotics in a way. This development aims to fill the need that we’ve had to eliminate the straight sticks, which ultimately improves a surgeon’s ergonomics. I know multiple surgeons with orthopedic injuries, neck injuries and back injuries that stem from long careers in laparoscopy who have switched to robotics just to prolong their careers.

Proper training

When you’re looking at a laparoscopic image, there are limits. The greens can be only so green, the reds only so red and the blues only so blue. However, the clarity, size and image density are all impressive with the newer technology.

The most significant change we’re going to see is not necessarily in bigger, better and clearer images, but rather in what’s beyond the white light we’re currently looking at. That’s why there’s a huge push towards fluorescence imaging to look at the perfusion of tissue, where nerves and urinary structures sit. With fluorescence imaging, you are extending your vision beyond the spectrum of white light. Laparoscopy improvements have basically plateaued not because of the development of robotics but rather because robotics wraps all these items — the image, the instruments and the haptic feedback — into one ecosystem that is completely unified and easy to operate.

If you are looking to upgrade your laparoscopy equipment, the first thing I would start with is a new camera head and new lenses. These imaging upgrades will eventually require a new computer processor system, but you can usually get away with staggering an update to your monitors.

There are external factors that we don’t really talk much about but that play a huge role in efficiency and patient and surgeon satisfaction. At the top of this list is the perioperative team that choreographs the surgery. It involves those who properly position the patient, secure them to the bed, hand you the instruments that you are missing and make sure the trays are prepped correctly. It can be a wonderful thing to watch when your staff is properly trained and know exactly what their roles entail.

Whether your facility is still performing laparoscopy or you’ve invested in robotics, understanding the technology is paramount to providing safe patient care. Your operating room team must work together to ensure all the equipment is functioning properly and understand what to do if a problem arises.

While robotics is taking minimally invasive surgery to new heights, advances to laparoscopic imaging equipment prove you can still deliver the safest possible outcomes without the flashiest technology. OSM