Universal Multifunctional Hd Video System for Minimally Invasive, Open and Micro Surgery

Nicholas N Nissen, MD, Vijay Menon, MD, James Williams, BA, Steven D Colquhoun, MD, George Berci, MD. Cedars-Sinai Medical Center, Los Angeles, CA


Introduction: Laparoscopy provides an important tool in the management of abdominal pathology, both as a method of staging prior to laparotomy and, increasingly, as a method of tumor removal. Some of the benefits of laparoscopic video systems include improved magnification and visualization of small structures, improved surgeon posture and fatigue, and use of the real-time video monitor and saved footage for documentation and education. The benefits of an intraoperative video system may be applicable to open surgery as well, but this has not been well explored.
Methods: We employed an HD video system to complement all phases of surgery including both laparoscopic and open aspects. For laparoscopy, a standard HD camera (1080p) is utilized for evaluation of operability (staging laparoscopy). In cases requiring exploration, a mechanical arm is attached to the operating table and the camera is mounted without the telescope, which provides video display of the case to all operating room participants. In cases requiring dissection or anastomosis of minute structures a special optical illumination system is attached to the same camera, which provides improved magnification and illumination for the surgeon. These critical components of surgery can then proceed with the surgeon working off the video monitor at a more convenient posture and with the benefits of video display. In select open cases the telescope can be reattached to the camera for inspection of areas that might otherwise be difficult to access, such as with diaphragmatic or retroperitoneal bleeding during a liver transplant or when draining multiloculated collections during pancreatic debridement.
Results/Conclusions: This approach of using a multifunctional video system for open abdominal surgery has been utilized in 85 complex hepatobiliary and pancreatic surgeries. Clear benefits include: 1) improved interaction with anesthesia and other personnel not having direct vision of the operative field, including scrub nurses; 2) improved teaching of bystanders and assistants who are able to observe the case in real time on a monitor; 3) improved visualization of minute structures and areas difficult to access; and 4) improved capture and utilization of surgical video and images for education and documentation without the need for outside or non-sterile photo equipment. The benefits of lessening surgeon fatigue or lowering the complication rate with the use of operative microscopy is suggested and requires further study. This system can be employed with little added costs over a standard laparoscopy setup and has the potential to be widely utilized in surgical education programs.

Session Number: SS02 – Instrumentation / Ergonomics
Program Number: S011

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