EH 2_2016

MONITORS IN SURGERY Opening up a new view for laparoscopy The ultra high-definition monitor High-def is suddenly so-yesterday for minimally invasive and endoscopic surgery Report: John Brosky The same 4K ultra-high-definition (UHD) technology that is surging as the next wave in consumer tel- evision has broken into the medical market with the presentation of two first-to-market laparoscopes. For those trying to get the big pic- ture, 4K ultra-high definition offers four times the resolution of the current generation of surgical high definition displays and, critically for keyhole surgeons, the camera on the laparoscope inserted into a patient’s body captures four times greater clarity of the surgical site and target organs. In 2013, consumer electronics giant Sony formed a joint venture with the dominant leader in endo- scopes Olympus Medical systems to develop the 4K technology for surgical endoscope systems and fur- ther applications of the technology to medical imaging systems, such as video microscopes. At that time Sony said it expected the market for surgical endoscopes would reach $4 billion in 2020. Three years later, Olympus is showcasing the Visera 4K UHD sys- tem that captures and displays 8.2 million pixels, which surpasses the company’s own Visera Elite intro- duced in 2011 with two million pixels. For an industry driven by incre- mental product changes, where products introduced in the past 18 months generate a third of annual revenues, the 4K overhaul of operat- ing rooms could fuel growth in the surgical segment for years to come. A sales representative with Olympus responsible for Germany said there are 1,200 hospitals in his territory and there is 100% pen- etration of HD systems some nine years after the first product was introduced. Even costing twice as much as HD, 4K systems will follow a similar adoption curve, he said, adding that Olympus had sold four Visera 4K UHD systems ahead of the market launch to two German hospitals. Still, Sony-Olympus were not the first to reach the market. The Synergy UHD4 imaging platform That honour belongs to orthopaedic surgical specialist Arthrex (Naples, Florida), which introduced the Synergy UHD4 in March 2015, at the annual meeting of the American Academy of Orthopaedic Surgeons. The Synergy UHD4 imaging plat- form features a programmable cam- era head, a xenon-bright LED light source, an image management sys- tem and fibre optic video over IP (internet protocol) integration all in one tablet-controlled device. Medical display specialist Barco connects the Arthrex Synergy UHD4 to its Nexxis OR Management Suite in order to demonstrate that its digital OR-over-IP system can easily handle the enormous data packets from the 4K camera and display them in medical-grade 4K monitors. In early November, Barco demon- strated its ability to plug in the 4K technology to the operating theatre (OT) in AZ Groeninge hospital in Kortrijk for a laparoscopic liver resection. Camera images encoded as IP packets can be sent to any dis- play device by cable or wirelessly, which cleans up the clutter in an OT and makes live images available for sharing at any authorised loca- tions, explained Johan Stockman, Barco’s vice president for Strategic Marketing for Surgical Imaging. Sony-Olympus utilises a similar approach to handle the 4K image files. In marketing the new products the phrase end-to-end becomes a key differentiator. Critically, the images from a live surgery must also be displayed on a 4K screen. Without closing the loop, the vivid value of the captured images is lost. It is also a signal that hospitals face significant end-to-end invest- ments in cameras, processors and monitors to upgrade to the 4K technology. ‘4K has emerged, it is coming and it will arrive,’ said Stockman. ‘It is on everyone’s agenda in the R&D labs right now, and will be on every surgeon’s wish list,’ he added. ‘If it improves surgical outcomes, hospi- tals are going to invest in it.’ The Visera 4K UHD system captures and displays 8.2 million pixels Pathologists more than welcome higher resolution images Medical heads turn to eye 4K and even 5K In sight: greater clarity for pathologists The equivalent of HD or Ultra-HD for home television and video is now entering the world of medicine. Although 4K technology with its high-resolution display quality is already used in radiology, there are areas that do not yet benefit from this advanced technology. However, the Japanese company Totoku Electric Co., Ltd. now offers a simple and effective solution for pathology where 4K technology is yet to be used. In our interview with Marcel Herrmann, Marketing Manager for the Medical Displays division at Totoku Europe, he underlined: ‘Pathology still works with analogue procedures in many areas, but high resolution images would be of huge benefit especially for these areas.’ Since talk about 4K technology, and even 5K, is widespread in medical circles, we asked Marcel Herrman of Toktoku Europe, why interest is so keen. ‘This technology delivers the type of high-resolution images that we already have in our homes and which are now conquering the world of medicine. In certain areas of medicine, such as radi- ology, high-resolution images are nothing new. Displays with five million to 15 million pixels are standard here. However, other areas, such as pathology, don’t yet benefit from these high-resolution images, although the advantages are obvi- ous. Pathologists need more details in their images than radiologists. To date they have viewed these through microscopes. ‘The current procedure in pathol- ogy involves scanning sections and then digitally viewing them at the workstation. Once the sections are digitised it’s easy to obtain a second opinion by digitally sending the sec- tions on. This also makes diagnosis easier. The practical implementation of 4K technology is relatively easy: All you need is a computer, a dis- play and a graphics card that can convert 4K, and almost all graphics cards these days are capable of this.’ With that simplicity, surely this technology should be far more established? ‘The difficulty is that apart from the computer and technical prerequi- sites for the technology display you also need sources that can deliver 4K. The technological solutions for this are comparatively expensive.’ Is this where Totoku’s solution comes into play? ‘We know that many people shy away from large investments but still want to jump from working with analogue procedures straight to 4K because they see the huge benefits, particularly for pathology. This is why we have developed a competitive solution, which still offers all the advantages of 4K tech- nology. ‘Many microscopes can connect to a single-lens reflex camera. This interface has been used for docu- mentation. However, if the interface is used to connect a 4K camera, which is then connected to the respective digital display, this deliv- ers an effective and affordable 4K solution, which we presented at the ECR in Vienna. ‘We are basically connecting two different areas here, using the experiences gained in professional broadcasting. TV and video produc- tion has long worked with very powerful cameras, which makes post-editing easier. Our technolo- gy solution is essentially based on experience with professional video equipment. Our answer to the prob- lem is basically a plug and play solution. ‘It would probably take years, or even decades, until the entire pathology workflow is digitised in the conventional way – and it will be expensive. Our solution shortens this process.’ Could the company venture into endoscopy with this solution? ‘Theoretically, yes, although endos- copy requirements are higher because even smaller sensors and camera technology are needed. This will most likely be possible in future Qualified as a radio and television engineer, Marcel Herrmann went on to complete a course in Marketing and Communication at the Academy for Marketing and Communication, Dusseldorf. He then spent seven years as a product manager before becoming Marketing Manager in the Medical Displays division at Totoku Europe in 2007. Continued on page 7 5 www.healthcare-in-europe.com

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