This article appears in the January/February print issue of Surgical Products.

Today’s operating room is a lot like the field of play at a sporting event. A team of like-minded individuals work together to execute a game plan with a specific goal in mind. Each member is trained to quickly and accurately perceive what is in front of him or her, react accordingly, and help achieve a desired outcome.

The sense of sight is a critical tool for athletes and OR professionals alike. However, the concept of sight and how it is employed in the OR has evolved quite a bit over time. Surgeons and other OR personnel have learned to evolve with these changes and overcome the various visual limitations of certain forms of surgery. While open procedures allow surgeons to see three dimensions with the naked eye,  the rise of minimally-invasive surgery in the late 1980s and early 1990s removed depth perception from the equation altogether. Now high-performance visualization technology is more prevalent than ever before. High-definition products are found in the vast majority of ORs around the country, and new 3D visualization products are starting to make their way into hospitals. However, one significant drawback to the development of OR visualization products is the difference between the visual dimensions available to staff present in the OR. What the surgeon and the council sees varies greatly from what the surgical assistant and the rest of the OR team sees. This disconnect is less than ideal, and it acts as a barrier between OR personnel.

“When we look at the modern day operating room, it’s really a team approach,” says Dr. John Valvo, Director of Robotic Surgery at New York’s Rochester General Hospital. “Everyone should have access to all of the assets that the surgeon has.”

Wishful Thinking (Until Now)

According to Dr. Valvo, OR personnel dependent on one another to do their jobs properly should be able to see the same visual information the same way. For example, no matter how effectively a council surgeon and bedside surgeon work together, the bedside surgeon lacks the depth perception the council surgeon has at his or her disposal.

“The difficulties therein are that the council surgeon needs the bedside surgeon to assist (him or her) with instrumentation, with passing equipment in and out, and needs not only to anticipate what the moves are, but also to be able to see them so that things are done precisely,” says Dr. Valvo.

However, he and his staff recently incorporated Sony's new 3D viewing and recording system for robotic surgery. The system allows for 3D viewing throughout the OR,  records the procedure, and allows for it to be viewed later in 3D. The most notable benefit of this system is everyone in the operating room can see exactly what the surgeon sees when he or she looks through Intuitive Surgical’s da Vinci robot kiosk. According to Dr. Valvo, this system has helped improve understanding and workflow between the surgeon, assistant, and other staff in the OR.

“Now that the bedside surgeon can see what the council surgeon sees, that symbiosis can occur much more quickly, much more accurately, with a much less chance of mistakes happening,” he says.

Great Expectations

Anytime a significant investment is made in a product, there are expectations with regards to performance and return on investment. Such was the case for Dr. Valvo and his colleagues at Rochester General Hospital when they purchased the Sony system. Likewise, for Dr. Daniel Eun and his associates at Temple University Hospital in Philadelphia, Penn.

“To some extent I think it exceeded our expectations,” says Dr. Valvo.

“Once we got it all set up, (the ROI) was almost instantaneous,” agrees Dr. Eun. “I am very pleased with the picture quality and the ease of use.”

Teaching Tool

To understand Dr. Eun and Dr. Valvo's  unequivocal praise and enthusiasm for 3D visualization in the OR, one must recognize their past experiences with similar technology.  According to Dr. Valvo, the early prototypes were somewhat difficult to use because they consisted of headgear or glasses that were uncomfortable to wear or caused headaches, among other issues. Meanwhile, Dr. Eun says he was determined to work in an environment where 3D visualization was available for both trainees and surgical assistants, as he had done when he trained at Detroit’s Henry Ford Hospital.

“While we were training and watching, we were not only sitting in the room observing,” says Dr. Eun of his training.

“I was learning the operations in 3D, and I thought that was a much better way to do this,” he continues.  “It doesn’t make much sense if the operating surgeon is the only person seeing in 3D.”

When he first took the job at Temple University Hospital, Dr. Eun sought to have an operating room designed and built around the da Vinci robot. He felt a critical component to the room was 3D visualization.

Temple has a dual suite with two rooms controlled out of one master control room. Dr. Eun and his staff operate out of the control room, which overlooks the two ORs. Two 70-inch televisions, one for each room, allow Dr. Eun to quickly and effectively perceive visual information. In teaching situations, he says, this gives him the confidence to allow trainees to do more.

“Before, I used to look at small TV screens, and I wasn’t sure exactly where they were so I’d have to pull the reins in faster,” he says. “(This system allows for) better quality training, and it also makes for a more enjoyable teaching experience.”

Both surgeons emphasized their appreciation for technology that allows them to train other surgeons more effectively. According to Dr. Valvo, the Sony system’s ability to record what’s happening in the OR -- in 3D -- is one of its most useful features.

“I think when one is learning something, you want to have some kind of data or foundation that you can go back to and determine how you are doing things,” he says.

“I think you can then do a lot more self-critiquing when you are reviewing something in the same mode that you actually performed, with regards to what you did right and what you want to do better,” he continues. “So I think there is a great advantage in that self-critiquing using this system as opposed to just recording it on a DVD and playing it back in 2D. You just don’t have the same feel. It’s not the same landscape.”

As someone who works in a teaching environment, Dr. Eun always looks for equipment and technology to help assist him in his efforts to prepare young and inexperienced surgeons for careers in the medical field. He strongly believes the latest technological advancements have made his roles as mentor, instructor, and advisor both easier and more enjoyable.

“If I’m operating in 3D and suddenly I step off and somebody takes over, I’d have to keep my head in the second console because we have a dual console system,” he says. “That was the only way to see where they were. Looking at 3D monitors just didn’t cut it. Now I can put on the 3D glasses and look on a heads-up display and see exactly where they are. I’ll tell you, in many cases the picture we see on the 70-inch 3D monitors is better and brighter than what we see in the surgeon console on the da Vinci system.”

Ready, Set, Go!

Being able to quickly incorporate the system into the OR helped both surgeons leverage its benefits immediately. According to Dr. Eun, the system’s wiring was already set up for 3D. Furthermore, in contrast to previous systems where a scope alignment was necessary, the Sony screens came pre-aligned.

“There was less tinkering around that we had to do,” he says.  “We turned it on and it was working. It was that level of simplicity that I was looking for.”

Both surgeons feel many types of facilities may benefit from the investment in this type of 3D visualization technology. According to Dr. Valvo, busy robotics centers, teaching centers, and facilities concerned with reducing mistakes in the OR may find 3D visualization to be a valuable asset.

“I think that this is for a health system that wants to be fully invested, one that wants to go in at a very high level,” says Dr. Eun.

“That’s what Temple had done,” he continues. “They decided to go all in on robotics and really invest fully in not only the surgeons and recruiting the right people to do the operations, but also getting high-end equipment. That way it would be not only a good way to show patients and the community that we were fully invested in this robotics program, but also a great recruiting tool.”

Technology has transformed the way sight is defined in the OR, and the innovative visualization tools being developed inside and outside the healthcare industry have surgeons and other hospital personnel excited for what the future may bring.

“There is a push toward 3D in our world,” says Dr. Valvo.

“One of the things that attracted me to robotic surgery was, as a surgeon, I wanted to be able to see with my naked eye what I was seeing before in the open arena,” he continues. “Laparoscopic surgery kind off cut that of for us. Now we can see what it is we want to do surgically, and this extends that to everyone else in the room. As we move to a much more integrated surgical team approach, it puts everybody on the same page.”

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