- Email: [email protected]
Low-cost, high-definition video documentation of corrective cleft surgeries using a fixed laparoscope
Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) 67, e58ee59
CORRESPONDENCE AND COMMUNICATION Low-cost, high-definition video documentation of corrective cleft surgeries using a fixed laparoscope Dear Sir, Critical to the treatment of children affected with cleft lip and palate is the training future surgeons to perform corrective cleft surgeries. Current educational resources include: textbook, intraoperative video, and computer animations. High quality video footage can be particularly useful as detailed information of surgical technique can be readily studied in ways that would be difficult to convey through a textbook. Intraoperative video recordings are traditionally obtained by professional videographers. These professionals usually produce high quality video footage but at a significant monetary cost. In addition, there are challenges to surgical video recording when the camera is placed far from the operative field, as head, hands, and surgical instruments can frequently obstruct the camera’s view.1 Overhead lights with video cameras suffer from these same limitations. In addition, recording intraoral cleft procedures such as soft palate repair and pharyngeal flap through the above methods can be limited as detailed images must be captured from the depth of the mouth. Currently, there is increasing popularity of high definition (HD) video which provides a sharper and more realistic capture of the recorded event. Professional HD cameras, however, are costly and intraoperative video recordings using these cameras suffer the same listed limitations. We present a cost-effective approach for high definition video documentation of corrective cleft surgery using readily available operating room technology. An 1188 HD 3Chip Camera was attached to a sterile 10-mm, 0-degree laparoscope (Stryker Endoscopy, San Jose, CA) for cleft lip repair and rhinoplasty repair and to a sterile 30-degree laparoscope for cleft palate and pharyngeal flap reconstruction. The camera was then fixed, and held in place using a Strong Arm clamp (Unique Surgical, Pittsboro, IN)
and a Quick-Grip Scope Holding Attachment (Unique Surgical, Pittsboro, IN). Images from the laparoscope were displayed on a 2100 HD monitor (Stryker Video System with Vision Elect) and appropriate camera position was confirmed by the operative surgeon. The field was then prepped and draped with care to minimally disrupt the operative field. As the laparoscope remained sterile during the procedure, camera manipulation was performed without contamination of the operative field. Utilizing a laparoscope for corrective cleft surgery recordings presents several advantages. Most operating rooms are equipped with laparoscopes normally used for minimally invasive surgeries or diagnostic endoscopic procedures. This presents a low-cost solution to obtaining highquality video of the procedure.2 In our series, the fixed position of the laparoscope minimized image distortion and movement. This is in contrast to the use of head-mounted cameras where image distortion is a problem3 and movement of the surgeon’s head can distract from the procedure. Furthermore, head-mounted cameras are fixed to the surgeon, which can lead to extraneous video clips and artifacts when the surgeon is not focused on the procedure.2 Because the laparoscopic camera does not need an operator, the surgeon can optimally arrange the set up, minimizing any conflicts of space with a potential cameraman or image distortion due to movement from a hand-held or head-mounted camera. The use of endoscopes to assist with cleft palate surgeries has been reported in the past. Raurell et al.4 used a 5-mm, 0-degree endoscope for intraoral viewing and a 2mm, 70-degree endoscope for transnasal viewing in performing two cleft palate surgeries. The 70-degree endoscope was hand-held to examine the nasal side of the palate and the posterior pharyngeal wall. The 0-degree endoscope was fixed using a similar system used in this report to visualize the transoral palatal procedure. Valente et al.5 used a 10-mm, 30-degree angle endoscope, a Telecam one-chip video camera, a xenon light source, and a 1400 Trinitron (Sony, Tokyo, Japan) high-resolution monitor to assist with palatoplasty in 11 patients. More generally, endoscopes and laparoscopes have been used for video, assisting, and illumination purposes in deep pelvis surgery, open abdominal surgery, and thyroidectomies.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.09.027
Correspondence and communication
e59 minimal disruption of the light source or image by heads, hands, or instruments. We believe the laparoscopic camera can positively benefit the training in corrective cleft surgeries.
Funding This research was performed without supplemental funding. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Figure 1 Image capture of an intravelar velooplasty cleft palate repair. Note the detail captured during this nasal mucosa dissection.
Conflict of interest The authors have no conflict of interest to report.
References
Figure 2 Image capture of a unilateral cleft lip repair. A hemi-membranous septum incision is demonstrated.
Ten corrective cleft surgeries were recorded using the methods described (Figures 1 and 2). Procedures include unilateral cleft lip repair, cleft palate repair, pharyngeal flap and rhinoplasty. All procedures were performed without incident or additional cost incurred on the surgeon. There was no need for additional lighting, and the need for overhead lights was obviated by the illumination provided by the laparoscope. There was no need for a videographer, additional operating room personnel or resident assistance to set up, hold, or manipulate the camera. As the patient position and field of interest remained relatively constant, there was minimal need to adjust the camera position, camera focus, or patient position during the procedure. Throughout the procedure, a high-resolution real-time image of the operative field was demonstrated on an intraoperative monitor. Due to the camera’s proximity to the operative field, there was
1. Flores RL, Deluccia N, Oliker A, et al. Creating a virtual surgical atlas of craniofacial procedures: part II. Surgical animations. Plast Reconstr Surg Dec 2010;126(6):2093e101. 2. Kothari SN, Broderick TJ, DeMaria EJ, et al. Evaluation of operative imaging techniques in surgical education. JSLS OcteDec 2004;8(4):367e71. 3. Cosman PH, Shearer CJ, Hugh TJ, et al. A novel approach to high definition, high-contrast video capture in abdominal surgery. Ann Surg Apr 2007;245(4):533e5. 4. Raurell A, Southern SJ, Fenton OM. Perioperative use of the endoscope in cleft palate surgery: a preliminary report. Ann Plast Surg Dec 2000;45(6):677e8. 5. Valente DS, Giglio A, Barcellos C, et al. Endoscopically assisted, intraorally approached palatoplasty. Plast Reconstr Surg Nov 2005;116(6):1820e1.
Patrick DeMoss School of Medicine, Indiana University, 340 West 10th Street, Indianapolis, IN 46202, USA Kariuki P. Murage Sunil Tholpady Michael Friel Robert J. Havlik Roberto L. Flores Division of Plastic Surgery, Riley Hospital for Children, Indiana University Medical Center, 702 Barnhill Drive, RI 2511, Indianapolis, IN 46202, USA E-mail address: [email protected]
28 May 2013
CORRESPONDENCE AND COMMUNICATION Low-cost, high-definition video documentation of corrective cleft surgeries using a fixed laparoscope Dear Sir, Critical to the treatment of children affected with cleft lip and palate is the training future surgeons to perform corrective cleft surgeries. Current educational resources include: textbook, intraoperative video, and computer animations. High quality video footage can be particularly useful as detailed information of surgical technique can be readily studied in ways that would be difficult to convey through a textbook. Intraoperative video recordings are traditionally obtained by professional videographers. These professionals usually produce high quality video footage but at a significant monetary cost. In addition, there are challenges to surgical video recording when the camera is placed far from the operative field, as head, hands, and surgical instruments can frequently obstruct the camera’s view.1 Overhead lights with video cameras suffer from these same limitations. In addition, recording intraoral cleft procedures such as soft palate repair and pharyngeal flap through the above methods can be limited as detailed images must be captured from the depth of the mouth. Currently, there is increasing popularity of high definition (HD) video which provides a sharper and more realistic capture of the recorded event. Professional HD cameras, however, are costly and intraoperative video recordings using these cameras suffer the same listed limitations. We present a cost-effective approach for high definition video documentation of corrective cleft surgery using readily available operating room technology. An 1188 HD 3Chip Camera was attached to a sterile 10-mm, 0-degree laparoscope (Stryker Endoscopy, San Jose, CA) for cleft lip repair and rhinoplasty repair and to a sterile 30-degree laparoscope for cleft palate and pharyngeal flap reconstruction. The camera was then fixed, and held in place using a Strong Arm clamp (Unique Surgical, Pittsboro, IN)
and a Quick-Grip Scope Holding Attachment (Unique Surgical, Pittsboro, IN). Images from the laparoscope were displayed on a 2100 HD monitor (Stryker Video System with Vision Elect) and appropriate camera position was confirmed by the operative surgeon. The field was then prepped and draped with care to minimally disrupt the operative field. As the laparoscope remained sterile during the procedure, camera manipulation was performed without contamination of the operative field. Utilizing a laparoscope for corrective cleft surgery recordings presents several advantages. Most operating rooms are equipped with laparoscopes normally used for minimally invasive surgeries or diagnostic endoscopic procedures. This presents a low-cost solution to obtaining highquality video of the procedure.2 In our series, the fixed position of the laparoscope minimized image distortion and movement. This is in contrast to the use of head-mounted cameras where image distortion is a problem3 and movement of the surgeon’s head can distract from the procedure. Furthermore, head-mounted cameras are fixed to the surgeon, which can lead to extraneous video clips and artifacts when the surgeon is not focused on the procedure.2 Because the laparoscopic camera does not need an operator, the surgeon can optimally arrange the set up, minimizing any conflicts of space with a potential cameraman or image distortion due to movement from a hand-held or head-mounted camera. The use of endoscopes to assist with cleft palate surgeries has been reported in the past. Raurell et al.4 used a 5-mm, 0-degree endoscope for intraoral viewing and a 2mm, 70-degree endoscope for transnasal viewing in performing two cleft palate surgeries. The 70-degree endoscope was hand-held to examine the nasal side of the palate and the posterior pharyngeal wall. The 0-degree endoscope was fixed using a similar system used in this report to visualize the transoral palatal procedure. Valente et al.5 used a 10-mm, 30-degree angle endoscope, a Telecam one-chip video camera, a xenon light source, and a 1400 Trinitron (Sony, Tokyo, Japan) high-resolution monitor to assist with palatoplasty in 11 patients. More generally, endoscopes and laparoscopes have been used for video, assisting, and illumination purposes in deep pelvis surgery, open abdominal surgery, and thyroidectomies.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.09.027
Correspondence and communication
e59 minimal disruption of the light source or image by heads, hands, or instruments. We believe the laparoscopic camera can positively benefit the training in corrective cleft surgeries.
Funding This research was performed without supplemental funding. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Figure 1 Image capture of an intravelar velooplasty cleft palate repair. Note the detail captured during this nasal mucosa dissection.
Conflict of interest The authors have no conflict of interest to report.
References
Figure 2 Image capture of a unilateral cleft lip repair. A hemi-membranous septum incision is demonstrated.
Ten corrective cleft surgeries were recorded using the methods described (Figures 1 and 2). Procedures include unilateral cleft lip repair, cleft palate repair, pharyngeal flap and rhinoplasty. All procedures were performed without incident or additional cost incurred on the surgeon. There was no need for additional lighting, and the need for overhead lights was obviated by the illumination provided by the laparoscope. There was no need for a videographer, additional operating room personnel or resident assistance to set up, hold, or manipulate the camera. As the patient position and field of interest remained relatively constant, there was minimal need to adjust the camera position, camera focus, or patient position during the procedure. Throughout the procedure, a high-resolution real-time image of the operative field was demonstrated on an intraoperative monitor. Due to the camera’s proximity to the operative field, there was
1. Flores RL, Deluccia N, Oliker A, et al. Creating a virtual surgical atlas of craniofacial procedures: part II. Surgical animations. Plast Reconstr Surg Dec 2010;126(6):2093e101. 2. Kothari SN, Broderick TJ, DeMaria EJ, et al. Evaluation of operative imaging techniques in surgical education. JSLS OcteDec 2004;8(4):367e71. 3. Cosman PH, Shearer CJ, Hugh TJ, et al. A novel approach to high definition, high-contrast video capture in abdominal surgery. Ann Surg Apr 2007;245(4):533e5. 4. Raurell A, Southern SJ, Fenton OM. Perioperative use of the endoscope in cleft palate surgery: a preliminary report. Ann Plast Surg Dec 2000;45(6):677e8. 5. Valente DS, Giglio A, Barcellos C, et al. Endoscopically assisted, intraorally approached palatoplasty. Plast Reconstr Surg Nov 2005;116(6):1820e1.
Patrick DeMoss School of Medicine, Indiana University, 340 West 10th Street, Indianapolis, IN 46202, USA Kariuki P. Murage Sunil Tholpady Michael Friel Robert J. Havlik Roberto L. Flores Division of Plastic Surgery, Riley Hospital for Children, Indiana University Medical Center, 702 Barnhill Drive, RI 2511, Indianapolis, IN 46202, USA E-mail address: [email protected]
28 May 2013