High Definition Endoscopic Video Systems

Anyone that has visited a consumer electronics store within the last two years can’t help but notice that we are in the midst of a HD revolution. High definition is the most significant change to occur in video systems since the move from black and white to color decades ago. This revolution has moved into the operating rooms of hospitals and surgery centers with the introduction of HD endoscopic camera systems [1]. More and more facilities are interested in moving towards HD systems for their OR, but are these facilities making the effort to make informed decisions for a substantial capital purchase.

The change is significant enough to require all the peripheral products, such as displays and recorders to be updated as well. For hospitals and surgery centers this means a large capital purchase that is unlike any purchase for endoscopic video systems they have made in the past. Additionally, purchasing managers and O.R. managers are making decisions on equipment that they don’t entirely understand. Unfortunately medical device manufacturers have made equipment decisions more difficult by marketing all kinds of products with the "HD“ moniker. How does a hospital or surgery center ensure that they make the right capital equipment decision regarding HD? Not an easy question to answer, but a critical question because an upgrade to HD endoscopic video is going to be a significant capital investment.

Fortunately for those involved in the purchasing process of HD video for hospitals and surgery centers, the video standards for High Definition are defined by the Advanced Television Systems Committee (ATSC). Understanding the standards for HD video is critical as some manufacturers have released and marketed products as “HD” that don’t adhere to the standards. Facilities that purchase the “non-standard HD product lines” will have increased cost in the future as they will once again have to replace all their peripherals.

Take for example a large facility on the West Coast of the United States that purchased 10 HD systems for their O.R. in 2007. All of the equipment was labeled “HD”, but none of the equipment purchased adhered to ATSC HD standards. The account purchased camera control units, camera heads, digital documentation systems and multiple LCD displays. In order to upgrade to HD systems that adhere to the ATSC HD standards, the facility will need to purchase new camera control units, new camera heads, digital documentation systems and new LDC displays for a cost of $50,000 per system. Unfortunately for this facility they will ultimately have no choice but to upgrade to a true HD system as non-standard HD systems will soon no longer be available.

It is critical that facilities determine their goals for the upgrade to HD video system for their operating room. Some facilities are upgrading to HD system in order to appease their surgeons. Surgeons may want HD video systems because they believe it makes the endoscopic surgery easier and there is evidence that this is true. True HD video systems have wider screens and in some procedures this increases the horizontal field of view. Additionally, there has been at least one study that indicates increased resolution improves three-dimensional perception [2]. Other facilities are upgrading to replace old equipment that is no longer reliable.

Since budgets are tight, making the proper decision on HD video systems is critical as some manufacturers offer features that can save surgical facilities time and money. One area that operating rooms can save money is the processing method. Steam sterilization of cameras and endoscopes can save between $10 to $40 a procedure versus chemical methods. Additionally, autoclave steam sterilization requires less time, so facilities can purchase less equipment lowering the original capital purchase. Another means for saving money on capital equipment is by purchasing equipment that can be upgraded in the future. Some of the HD systems on the market are FPGA based designs, which enables the manufacturer to upgrade the firmware and software enabling them to provide new features. Equipment that can be upgraded and is forward compatible with future technology has the advantage of providing users with the latest technology while keeping the overall cost of ownership down. In the case of the large facility mentioned above that purchased non-standard HD equipment, the equipment is not forward compatible. If the account had made a different decision and purchased an ATSC recognized HD system that was FGPA based, their upgrade cost would have been significantly less, in the range of $8,000 per system.

The decision to purchase HD video systems for operating rooms can be exciting, but extremely stressful for those involved in the process. In many cases, however, those involved in the decision defer to others because they do not understand the technology or they will make their decision based on market share or their relationship with sales representatives. A wrong decision will cause end up costing facilities, either with increased operational costs or loss of revenue. How do you ensure that your hospital or surgery center makes the most educated and best decision? There’s never a foolproof way, but you can minimize the risk.

 Properly researching the technology and understanding the ATSC standards should at the very least enable facilities to ask manufacturers the right questions:

• What is the native pixel count?
• Is this progressive or interlace scan?
• Is the system upgradeable?
• Can I steam sterilize the camera?
• What peripherals are compatible? 

Conducting a thorough evaluation of the HD system will tell a facility if the equipment is clinically acceptable and what, if any problems may occur after the equipment is installed.

Additionally, a thorough evaluation should enable a facility to verify the features marketed by the manufacturers really work. For example, there are really only a couple of manufacturers that make reliable autoclavable video products. However, several other companies have autoclavable products as part of their offering, but only when it gets to the evaluation will they confess that the product should not be autoclaved except during an emergency. Following an evaluation, and prior to making capital equipment, facilities should always seek and contact references, especially with new technology. Contacting other users can help predict your facilities’ experience as well as build confidence in your decision.

The introduction of HD technology to the operating room is exciting, as it offers surgeons video quality they never thought imaginable. For those involved in the purchasing process, upgrading to HD is a bit intimidating. In the past there was less risk because the technology was so similar to what facilities were previously using. With the tight constraints of today’s budgets, it is essential that hospitals and surgery centers make educated and informed decisions when purchasing HD video equipment, particularly understanding how these decisions will impact operational budgets over time.

References:
[1] “In the US, sales of HD camera systems are expected to completely replace those of standard-definition three-chip camera systems by 2010.”  - High-Definition Technology to Revolutionize US & European Visualization Device Markets by Millennium Research Group.
[2] Video-assisted surgery represents more than a loss of three-dimensional vision by Anthony G. Gallagher, Ph.D, E. Matt Ritter, M.D., Andrew B. Lederman, M.D., David A. McClusky III, M.D., C. Daniel Smith, M.D., The American Journal of Surgery 189 (2005)76-80 Laparoscopy.