By: Mairead Smith

Video endoscopy systems are used to view live, color images of the interior of the body during diagnostic and therapeutic minimally invasive surgery. While the systems have been in wide use since the 1980s, recent technology enhancements are providing new options for purchasers. Improvements in visualization continue to occur, such as the transition from standard definition (SD) to high definition (HD), the growing availability and popularity of ultra-high definition (4k) systems and the development of three-dimensional (3-D) surgical video systems. The vast majority (81 percent) of facilities are currently using two-dimensional (2-D) HD systems, according to data submitted by ECRI Institute’s SELECTplus member hospitals from February 2015 to February 2016.

Migration to high definition systems
The main technological enhancement that HD systems offer is the ability to capture and display more imaging data, resulting in a higher image quality, than SD systems. Current HD systems typically output a 1080p image in a widescreen (letterbox) format. 4K systems, which output an image with 4 times as many pixels (2160p) as HD systems, are just starting to penetrate the medical market. 3-D HD systems offer surgeons greater depth perception than 2-D systems, which may help improve the surgeon’s accuracy, reduce error rates and decrease the time required for certain surgical tasks. Clinical areas where 3-D vision is in high demand include gynecology, urology and general surgery. 3-D systems have been on the market for more than 10 years, but gained little traction until recently, when historical challenges with 3-D technology and image quality have been addressed. Member interest in 3-D systems began to pick up in 2013 and increased by 50 percent from 2014 to 2015. Currently, we see an interest in four manufacturers of 3-D systems: CONMED, Karl Storz, Olympus and Visionsense. Some manufacturers offer modular platforms that can be upgraded from 2-D to 3-D. The standard components of surgical video endoscopy systems include the following:

• Camera control unit (CCU) or video processor
• Information management device
• Video display
• Light source
• Video camera or camera head
• Endoscope
• 3-D systems require a 3-D-ready display, 3-D glasses and special 3-D stereoscopic scopes with two optical channels

Purchase considerations
Clinical applications for video endoscopy systems include minimally invasive surgical (MIS) procedures that do not require more advanced technology (e.g., a surgical robot), as well as diagnostic procedures using a flexible endoscope. Facilities and clinical departments that would use this device include operating rooms/surgical facilities and endoscopy suites. The typical users would include surgeons, operating room nurses and operating room technicians. In general, the configuration of a surgical video system depends on which ORs it will be used in and the hospital’s volume of MIS procedures.

For example:

• In many facilities, CCUs, information management devices, displays and light sources are mounted on mobile carts, allowing them to be transported between surgical suites and/or repositioned to meet space requirements.

• Hospitals with higher MIS volumes may have ORs dedicated to MIS procedures, in which displays may be permanently mounted on articulating arms of surgical booms, and light sources and CCUs may be located on one of the boom’s shelves to enable convenient positioning during the surgical procedure.

• A surgical video system can also be permanently installed in an integrated OR, where routing of video signals to various destinations is controlled from a central location, either within the OR or the surgical department. When selecting a surgical video system, facilities should consider a number of options, including:

• Video performance (video performance affects the surgeon’s ability to detect and differentiate between different tissues and blood vessels);

• Compatibility of components (image quality and/or size may be compromised if the signal from the CCU does not match the monitor input); and

• The availability and efficacy of advanced imaging modes. Several advanced imaging modes are now available to enhance video images in real time with the aim of increasing the conspicuousness of subtle details. As a result, these modes may help improve diagnostic accuracy or reduce errors during procedures.

Average quoted costs are based upon a complete HD surgical video endoscopy system along with two laparoscopes. Costs can vary significantly depending upon the model and system configuration. Surgical video endoscopy systems have an estimated service life of at least five years. Although system components can last much longer (depending upon usage), manufacturers tend to introduce new systems every three to four years touting better image quality and greater image enhancement features. Is it time to consider replacing or upgrading your system? ECRI Institute’s Health Devices System and SELECTplus programs offer guidance on not only the evaluative criteria that are essential to understanding the systems, but also the experience to assist facilities in determining which systems best suit their specific needs.

ECRI Institute’s Healthcare Product Comparison, a database of specifications for
capital medical devices, offers ECRI’s Recommended Specifications — our experts’ opinion on the minimum performance requirements for a device. This offers additional guidance in the selection of a system. For nearly 50 years, ECRI Institute, a nonprofit organization, has been dedicated to bringing the discipline of applied scientific research to discover which medical procedures, devices, drugs and processes are best. To learn more, visit www.ecri.org or call 610- 825-6000, ext. 5891.

About the authors: Kevin Lee is project lead, SELECTplus, and Mairead Smith is project officer, Health Devices Group, at ECRI Institute.