HD surgery provides gruesome level of detail

High-definition capture and monitoring equipment has long been available for medical uses, but for whatever reason, widespread use has yet to catch on. Now, however, you people will be able to um, partake, in viewing the "first HDTV surgery ever broadcast" as National Geographic HD airs a special presentation of the 1080p system in action. According to a doctor that actually got to experience the technology first-hand, the KSEA HDTV Surgical System provides a widescreen, Full HD look at what's going on within, employs a 3CCD camera with an acquisition resolution of 1,920 x 1,080, and outputs an image that is progressively scanned and displayed at 60 full frames-per-second. We'd recommend you tune in to the aforementioned show on September 16th if the channel is available in your neck of the woods, but you may want to click on and see a few stills of the KSEA in action before subjecting yourself (read: your weak stomach) to the real deal.

[Thanks, Dr. Steven P.]

[papari @ Aug 4th 2007 7:34PM]

Engoatsed

[sldkjf @ Aug 4th 2007 7:46PM]

amazing that this resolution is only now being adopted, while walmart has had these panels for over a year for rednecks to watch nascar on. as an aside, one OR i've been in had a large, widescreen HDTV plasma, but the image was obviously the incorrect image and aspect ratio. it was for the families to watch the operation on.

[Tha Key @ Aug 5th 2007 1:06AM]

I'm hoping for it to drop on bluray, so my PS3 can get some serious visual candy.

myspace.com/thekeytothelock

[korockid @ Aug 4th 2007 8:20PM]

i feel sick.

[Dan @ Aug 4th 2007 8:41PM]

Cool. 1080p surgery.

[rob13 @ Aug 4th 2007 9:18PM]

is this by any chance gynecological surgery?

[frankmu @ Aug 4th 2007 10:25PM]

looks like a prostate to me

[Revrant2394 @ Aug 4th 2007 10:27PM]

Ding! +10 Fear of Colonoscopy Buff

[Brendon @ Aug 4th 2007 11:12PM]

Surprised to see something I worked on here. This product went to market in March but I guess five months late is better than nothing.

[sldkjf @ Aug 4th 2007 11:53PM]

why, when HDTV has been around for 15 years, has it only now been adopted in laparoscopy?

[JJ @ Aug 5th 2007 12:03AM]

The only thing I could think of why the medical field is late to adopting this feature is probably cost. Considering the rise of healthcare costs and the number of hospitals being closed down (well, in California), and the rise in obesity and other detrimental health factors that give rise to insurance costs, I'm sure money was the biggest issue.

[Steve @ Aug 5th 2007 9:51AM]

It's a lot less about money and a lot more about a lack of vision (as in future) and an resistance of multiple establishments to change (surgeons, the OR purchasers, the hospitals and even the equipment makers themselves).

[sldkjf @ Aug 5th 2007 11:13AM]

this is the answer i was looking for. i hate the medical industry (i'm a physician).

[michas_pi @ Aug 5th 2007 12:12AM]

I'm a volunteer at Cleveland Clinic surgical department and most of the OR's have HDTVs, albeit not 3CCD camera systems. Most procedures are recorded on DVDs (not just laproscopic procedures). It's awesome to stop what I'm doing sometimes and see laproscopic surgery on a big 50 inch plasma screen.


Of course, it's even more awesome to stand right behind the surgeons and view operations from there.

[michas_pi @ Aug 5th 2007 12:13AM]

Whoops, I forgot the "the" after "at" and before "Cleveland". Silly me.

[michas_pi @ Aug 5th 2007 12:15AM]

Also I forgot to add that the other big company names in medical imaging are Olympus, Steris, and Stryker. Can't wait to see what they have to offer in terms of HD-quality video capture.

[Kevin @ Aug 6th 2007 1:30AM]

Add Pentax to that list. Seen their HD scopes in action, the detail is amazing.

[bwobo @ Aug 5th 2007 12:27AM]

cool to see this up. I know Intuitive and their DaVinci use HD with their camera, and I think thats the unit I saw, it looks familiar. I know some people over there and I actually got to use the Davinci (on test stuff, not people lol), one that was hooked up to HD. Pretty cool stuff.

[bwobo @ Aug 5th 2007 12:31AM]

actually the da Vinci S system, rather than the original da Vinci

[mouses_man @ Aug 5th 2007 12:57AM]

yummy!

[Keaton @ Aug 5th 2007 2:14AM]

Munch Munch...

[Hawk @ Aug 5th 2007 3:40AM]

hey guyz see the new invention in which an microchip is implanted in an human hand called "VeriChip" they provide all the precious data relationg to human body, they also provide variou info relatig to an identity of aperson see the full info here-
http://sayanything.awardspace.com/2007/08/03/microchips-in-humans-high-tech-helpers-or-big-brother-surveillance/

[OC @ Aug 5th 2007 4:42AM]

Don't get me wrong, these are very shiny indeed, but show me some evidence that it actually improves outcomes for patients. I suspect THAT (not "money") is the real reason why HD monitors are only slowly being adopted for endoscopic surgery - in order to justify the cost one would have to demonstrate some tangible benefit (beyond just making OR staff go "ooh" and "aah").

[Steve @ Aug 5th 2007 9:52AM]

In this case, it is not all about evidence. It's more about ergonomics. You might not be able to prove an improvement in patient outcomes but it's still very important what makes the surgeon more comfortable.

For example take your average programmer. They can sit on a $5 fold-out Walmart chair all day or a $50 office chair. Does having the more expensive chair improve the code they produce? Probably not (and less likely to be proven) but would you like to be the one sitting on that cheaper chair all day or be the one under the knife while your surgeon uses inferior equipment just because you can't prove it improves YOUR outcome?

[OC @ Aug 5th 2007 9:00PM]

Fair point!

We have one LCD panel laparoscopic stack (I think it's SD though) at the hospital where I work, which is strange because the tertiary hospital just up the road doesn't have any, they're all still CRT! Compared to the old LCD monitors the LCD is a joy to behold and certainly makes operating more pleasant... but I don't think it's saved any lives to be honest.

Maybe for smaller hospitals that only need to purchase one or two units (as opposed to ten or twelve) the difference in price wouldn't be such a big deal. And maybe private hospitals might be more interested in investing in this sort of equipment.

I guess it comes down to government/health departments/private enterprise to decide how they want to spend their dollars. I know here in Aus., where a perfectly acceptable and cheaper alternative exists (old school CRT stacks) the "superior" LCD option would have to demonstrably produce measurably superior results in order to justify spending large amounts of money to make it the "standard".

Nice though.

[Ricardo @ Aug 5th 2007 9:04AM]

That doesn't look like full HD. The stills look like they have been interpolated or something. What I mean is that the real pixels are larger than the logical ones. I wouldn't be surprised that a lens this size couldn't capture all the detail in a full HD image.

[Steven Palter, MD @ Aug 5th 2007 10:56AM]

I am the surgeon in the post who used the equipment. I can address many of the comments and questions above. First the timing of the introduction of HDTV to surgery. I performed the world's first HDTV laparoscopy in 2000. At that time it took me more than a YEAR of convincing to get a consumer compnay to adapt a cmera for medical use. The major issue initially was that the medical video market is a tiny dot of a fraction of the consumer video market. The major companies were all focused on developing HDTV for your living room and nor for the relatively small and highly regulated medical markets. in 2001 I broadcast HDTV surgery at a major medical conference and the majority of those in the audience polled with audience feedback system were amazed and wanted to use the system. Many of the above comments are correct. 1) In my subjective experience the use of HD for laparoscopy give s a much clearer picture and reduces fatigue and is much easier to work with. It allows the visualization of smaller detail and lesions. Direct clinical outcome improvement has not been proven yet not directly studied yet. The same transitions have been seen with every generation going back to low res single chip camera to today's systems. Every single resolution improvement has improved the surgery in my eyes but yes I "can" do it with a lower res system. I can watch TV in SD but I prefer HD. The same is true for the same reasons when I operate. These systems will likely replace SD systems over the years as every single resolution improvement has done to its earlier model. You don't use super 8 video any more and VHS camcorders are no longer being bought. Try to find regular VHS recorders or even a SVHS one in local stores. 2) economics- yes an issue. manufacturers will have to provide dramatic improvements in quality or no one will spend the money to upgrade. The pictures are very very different to my eyes! 3) the still photos- we did not have a HD still capture set up only the XDCAM HD system for National Geographic. To fit our recording needs to send the show to them we had to convert to 1080i on the recorded footage only. Good eyes! the photos are frame grabs from out converted video and far inferior to the live feed we saw.

This will be the first time surgery is broadcast in HD for the lay public- I am getting lots of comments that the "gross-out" factor is an all time high! I think the shots are beautiful but hey I am a surgeon.

Details of the systems are here
http://docinthemachine.com/2007/08/02/recordhd/

details of the recording set-up we used are here
http://docinthemachine.com/2007/08/02/recordhd/

[sldkjf @ Aug 8th 2007 2:23PM]

amazing that UPMC hasn't gotten this. They just built a new OR (the one with the plasma) for Neil Kassam to do his transnasal stuff, and that doesn't have HD. Cheap ass Pittsburgh.

[Ricardo @ Aug 5th 2007 5:16PM]

Thanks for your reply Steven.

I was hoping the low image quality was the result of loss of data due to some kind of conversion, and you just confirmed that. Good to hear!

[William Halverson @ Aug 7th 2007 11:54AM]

High Gross-out? What could be more gross than watching reality TV, with midgets competing for vacation give-aways, families swapping wives, and morbidly obese people competing to lose weight for money? I can see why the mullahs call us 'the great Satan'. If anything, your broadcast will be a boon to surgical specialty recruitment. If the Air force thinks video games will help recruit fighter pilots, who knows what the HD broadcast can accomplish.

On a professional note, can you broadcast the video streams over IP networks? We have broadcast laparoscopic procedures using SD cameras and H323 video codecs. Stryker repackages various devices [including a POLYCOM codec] to allow video broadcast from the OR.

There is a HD video conferencing company called "Lifesize" that does a very good job of "HD-like" video but their data sheets do not talk about the encoding of the bitstreams. TANDBERG only does 720p but at rates below 30fps. I don't know if any of the video conferencing codec companies [POLYCOM, TANDBERG, etc.] do 1020p yet.

Best regards, full steam ahead!

William Halverson

[OC @ Aug 5th 2007 9:03PM]

Steven - thanks for the post, interesting stuff! Do you think it'll become standard? What sort of timeframe?

[Andrew H. @ Aug 6th 2007 2:17AM]

i'll stick with my trauma centre in sd thank you very much

[Steven F. Palter, MD @ Aug 6th 2007 10:10PM]

OC-- the major surgical endoscope companies are alomost all introducing HD systems. Past experience has been that the lower res systems are gradually replaced. As time passes moore's as with consumer video the price differential decreases (that is if the lower res chips and systems are even still produced). Leading centers are upgrading now. The time frame for the complete trickle down is uncertain especially outside of the USA. There are differences in resolution between systems however today even in the HD offerings.

[booger62 @ Aug 7th 2007 1:38AM]

mmmmm, blood.

[David Mccann @ Sep 3rd 2007 5:45PM]

Lifesize as William points out does provide a great HD VTC solution. To answer his question directly Lifesize does decode and encode at both 30fps so the motion handling is not jerky like traditional VTC systems.