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Both sides of 4K: suppliers and a surgeon evaluate the potential of the systems.


Although enhanced visualization systems offer some benefits for open procedures, they are intended for laparoscopic and endoscopic procedures, especially as the later has evolved into a therapeutic tool. The 3D systems have been available for a few years and have found a niche in training and robotic procedures. But, the launch of 4K in the past year has brought larger screens with four times the resolution into operating rooms. The corresponding scopes, cameras, recorders and connectivity systems have followed, meaning for the first time surgical teams are able to see true 4K images, not just high-definition (HD) images enhanced to 4K quality.

Because these systems are so new, clinical data has yet to be published and objective, peer reviewed studies with large research segments are even further out. Suppliers anticipate this data will start to emerge early this summer.

For now, the arguments for 4K systems include:

1. A larger, more detailed image will improve outcomes and efficiency by providing the surgeon and their team with more information.

2. Enhanced color will allow surgeons to observe fine patterns and tissue in the body in high precision, often associated with 3D visualization.

3. The 4K screen can be structured as a quadra-screen, offering four, high-definition images within the surgeon's line of site.

When data is published supporting these three points, it is hard to imagine there would not be a shift to 4K. Until then, suppliers will be answering question from skeptics. To hear both sides, Surgical Products reached out to industry experts.

Improved Outcomes and Efficiency

The concept of 4K and its impact on outcomes and efficiency seems pretty clear--if surgeons and surgical team members have a clearer image, then they should be able to perform the procedure better and quicker. Even with a HD screen, there will be image degradation the closer to the monitor a person gets, Evan Krachman, product manager and new business development at Sony Medical, said. "With 4K, that does not happen. The closer you go, the better it looks, because there is four times the resolution. It is like taking a microscope and being able to zoom in four times while maintaining that super sharp focus, which you could not do with HD."

This sounds like a valid opportunity, but until data is released,

Dr. Jay Redan says he is not sure it will become widely adopted. He is the past president of the Society of Laparoendoscopic Surgeons (SLS) and the medical director of minimally invasive general surgery at Florida Hospital Celebration Health, in addition to being the director of the chronic abdominal and pelvic pain program at Celebration Health.

"With the Affordable Care Act, we have to be economically responsible in our decisions" he explained. "If a monitor is going to give me better patient outcomes, safer operations and it costs a little more, I have no problem with that"

Yet, as the past-president of SLS, he remains hesitant. "I would need concrete evidence to show why I am going to stick my neck out there and explain why you should buy a 4K or 3D system. Right now, I cannot do that"

Depth Perception of 3D--Almost

That has not stopped the concept of these 4K devices from becoming popular, and the main reason is because of the depth and color these screens offer. Although they are not 3D monitors, the depth perception offered is one of the first things clinicians notice. Patrick McCullough, senior product manager of imaging at Olympus America Inc., says those comments are the result of three things--light, color and resolution. "Enhanced light allows a clear image to exist in sub-optimal conditions," he explained. "Expanded color allows surgeons to discern adjoining tissues or fluids that may otherwise be confused. Finally, increased resolution allows for the identification of fine structures and the magnification of an image on a large format operative display."

Just like with 3D systems that have become popular in robotic surgery and training centers, this depth perception is associated with improved navigation and, theoretically, improved outcomes with less unintended tissue damage.

To rebut, Redan mentioned again that until data comes out to support this enhanced system, it might be more of a luxury than a necessity.

"It will look nice, but I need someone to show me it is going to improve outcomes, reduce errors, lower infection rates and reduce case time" he said.


The main feature of 4K systems in minimally invasive procedures is to provide more information to the surgical team. Offering quadra-screen feeds into this as imaging, vitals and other data can be brought to one place, instead of multiple screens which clears floor clutter and improves efficiency. How and where images appear can be controlled on a tablet by a nurse or another surgical team member.

Redan pointed out to make this affective the system has to be fluid and all data inputs had to be cohesive. "It is only as good as the weakest link" he said.

Next Steps in Visualization

Facilities are still transitioning from standard to HD monitors, and the thought of 4K and its potential seems years away. So, when conversations about the next steps after 4K, such as to 8K and to 4K 3D, which are projected to emerge later this year, it is easy for suppliers to understand the wide-eyed looks from purchasing committees and surgical teams.

The reality is this transition does not have to be made all at once--it can be gradual. Krachman said he has worked with customers who have transitioned to HD, but think a 4K screen offered more potential. The technology is available for a HD image to be scaled up to 4K so, while it is not a true 4K image, it is still higher quality than the HD image they were working with before.

Also, when a facility is transitioning from a standard definition system to HD, they can anticipate their next move to 4K by installing a system compatible with both. This method requires more initial planning, but it could offer long-term benefits and savings. Suppliers and many clinicians see 4K not as an 'if' but 'when' "We believe the market will shift as soon as customers understand the impact advanced imaging systems can have on their decision-making process in the OR," says McCullough. "It is anticipated this shift will be even shorter than the last evolution in imaging from standard definition to high definition." Experts at Sony agreed. "If you can see more and show a surgeon more, why would you not do that, especially with nuances of color, blood and tissue?" Anne Bondulich, marketing manager for surgical products at Sony Medical, said.


Redan acknowledges the appealing potential of the devices--he just wants the data first.

Rebecca Rudolph-Witt, editor
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Title Annotation:OR Visualization
Author:Rudolph-Witt, Rebecca
Publication:Surgical Products
Article Type:Cover story
Date:Apr 1, 2016
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