World’s Highest Resolution HDTV Surgical Camera – Ever! – First Exclusive Evaluation

Posted on July 31, 2007 by Steven F. Palter, MD

I have previously posted about my research on the use of high definition TV (HDTV) for surgical endoscopy. I am honored to have participated in the evaluation of the highest resolution surgical system ever created which I used to capture the footage showcased in the amazing upcoming National Geographic HD special “Inside The Living Body” which will be the first surgical procedure broadcast in HD.

What’s also new is that this system allowed me to record footage that will be seen by the lay public in their living room that is higher resolution and quality than virtually any surgeon has ever seen in the OR!

In this post I want to review the system used and how it differs from other surgical systems. This will also give me a chance to review many of the failings of HD systems in use in the OR today as well as provide surgeons with important caveats in choosing a system. I’ll also provide you with some photos and stills from the system and further details of the National Geographic TV special.

For those interested in the history of HDTV surgery and the details of its development further details of my work are here from the New York Times and here from Science Daily and here from MIT Technology Review.

Development of the World’s Highest Resolution Surgical Camera System Ever! Ever since I helped develop HDTV surgery I have had a close relationship with both the manufacturers of surgical video systems and tools and those in the video business itself. It took more than 5 years from that first procedure for each of the major surgical video companies to come around and embrace HDTV as the next innovation (even those there is a huge difference in quality and design) between the systems.

You can imagine my delight when I was approached by Thomas Prescher (Director of Upstream Marketing) at Karl Storz Endoscopy America (KSEA) to evaluate and critique a unique new prototype HDTV surgical system with the highest resolution ever. I have known Thomas for many years since he first came to the USA from Germany to lead the gyn marketing at Olympus Surgical (where we collaborated on research on head mounted displays, microendoscopy, among others). At Karl Storz Thomas is helping to really push the envelope of technological innovation in endoscopy and is someone who shares much of my vision for the transformation of surgery in the future. They have even launched a website on HD endoscopy. Besides this HD project we collaborated on the development and testing of the autofluorescence based endocopy system that was awarded prizes at the AAGL, SLS, and ASRM meetings earlier this year.

I was truly impressed when I tested the system and can say that it is the highest resolution images I have ever seen in endoscopy. Those assisting me in the OR stood with their mouths open in amazement at the beauty of the images and started calling for other surgeons to see what I was doing. We were operating for the first time with a chip that was imaging at 1920 x 1080p (beyond WUXGA for you computer geeks).

One week later I received a call from the National Geographic Producers in London who got wind of my work and were requesting copies of some of the footage for use in their upcoming HDTV show on human body. They were thrilled that I could provide them with HD footage that would be the first ever HDTV surgery ever broadcast in the world. I jumped at the chance to share my passion for this amazing tool with the lay public and my patients fought for the chance to be the uterus seen around the world. For more than 5 years I have lectured and spoken on why HDTV surgery can help advance endoscopic surgery.

Details of the KSEA HDTV Surgical System - The Karl Storz Image1 HD Video System is unique in having a native chip resolution of 1920 x 1080p in the first ever (for surgery) 16:9 aspect ratio (Full HD). This HD system employs a 3CCD camera with an acquisition resolution (at the chip) of 1920 x 1080. This translates to approximately 2 megapixel video. The image is progressively scanned outputting 60 full frames per second, versus the 60 half-frames or fields output by interlaced systems. This provides full detail with twice the frequency and also minimizes motion artifacts caused by rapid movement- vital for smooth surgery.

Advantages of The System:

highest resolution ever for a medical endoscopic camera. Allows the surgeon to see finer detail and clearer images. It remains to be seen if this will allow the visualization of smaller disease implants but it seems likely.
This high resolution is native from the chip not interpolated by the camera system or faked with post chip processing (much more on this in the follow up posts on will the true HD please stand up).
Progressive scanned image smooths the motion seen and reduces motion artifacts.
First ever wide 16:9 aspect ratio. Gives more lateral detail and information during surgery. Just like the differences you see in wide aspect ratio TV’s vs standard.
First ever ability to record images at full 1080 HD resolution for teaching and archiving. More about this later but this is what we used for National Geographic.

First Ever Surgical 16:9 Monitor: It is displayed on a 16:9 ”WideView monitor” with the same native resolution (1920 x 1200) so that the full 1920 x 1080 image can be displayed without degradation. The advantage of using this is that it will maximize the horizontal field of view of the surgeon. In general we operate in a horizontal plane with our instruments next to each other. A true wide aspect ratio monitor will allow a wider lateral field of view and give more space to operate under direct vision as well as allow the surgeon to see instruments entering his field of view earlier. (Editorial Note: I can remember sitting in the courtyard at Patty O’Brien’s in New Orleans at 1 AM with Thomas drawing out this concept on a napkin – during the American Society for Reproductive Medicine Conference Last November- and being convinced of the potential benefits as we debated what technology could transform surgery in the next decade – but that’s another story- podcast on this topic here. Not surprising that a late night social event turned into yet another medical technology brainstorming session past midnight for me!).

This is the HUGE field of view obtained with this first ever 16:9 system!- Shot from my OR

Images From the System: –

note these are screen grabs from the video - actual images are higher res with less motion artifacts

(click for hi res image)

click for hi res bowel

click for high resolution tubal photo

Read here on what we had to do to record the footage from the OR in HD and get it to National Geographic using a new HD recording system based on blu-ray

Come back to see follow up posts on what was created to allow true HD reacording of these images and how so much HD in the livining room and the OR is not really true HD or set up incorrectly negating its potential benefits.

National Geographic’s The Living Body: DITM Featured in World’s First HDTV Broadcast of Surgical Procedure

Posted on July 24, 2007 by Steven F. Palter, MD

I’ve mentioned the National Geographic Special “The Living Body” and wanted to fill you in on why this is such an exciting project for me. The show follows a woman from birth through life and death and traces the function of all of her bodily systems. It will feature my surgical laparoscopy footage as the world’s first broadcast of surgery in HDTV. To produce this I used a protype laparoscopy system that visualizes the highest resolution images ever seen of the human body. If you watch this show you’ll see endoscopic images on your living room HDTV set better than almost any surgeon has seen in the OR!

I became involved when I received a call from the NG people and ther production team out of London. They had heard of my work in developing HDTV endoscopic surgery and that I had performed the world’s first HDTV laparoscopy back in 2000. This show was being produced in HDTV for braodcast in HD on the National Geographic HD channel (then downconverted to standard definition-SD for traditional broadcast and DVDs). They were looking for some HD footage of internal organs.

The original HD projects I did back in 2000 used a prototype 4-chip HD from JVC camera modified from a microscope camera for use in laparoscopic surgery. At that time we had to use a w-vhs recorder as this was the only way to record the 1080i signal in HD.

I became very excited at the prospect of helping them with this project since I had been testing a new endoscopic system that was unique in having the world’s highest reolution ever as well as the ability to record in full lossless HD using a new type of blu-ray HD DVD based recording system.

I recorded a series of shots for them of all the internal pelvic and abdominal organs and am delighted it made the final edit of the show. You’ll see an egg developing inside an ovarian follicle, the bowel, liver and gall bladder, fallopian tubes, cervix and uterus.

My next post will review the technolgy between the HDTV system I used and some images from it.

National Geographic Update- HDTV Surgery: (United Airlines Sucks!)

Posted on July 24, 2007 by Steven F. Palter, MD

Well the TCA television critics association meeting is over. What an enormous logistical nightmare this was for me! AS I previously wrote, I was invited to a press briefing by the amazing folks at National Geographic. Here’s how it played out. Unfortunately, United Airlines cancelled my flight at the last moment due to “mechanical difficulties” with my “broken plane”. Despite literally hours and hours of logistical maneuvering (different flights, all three NY airports, and endless time on hold with UAL customer support in India) there was simply no flight that could get me there before the press session started. This was without taking the reported 20%-40% on-time record (amazing!) of some of their flights into consideration. I was unable to attend but happily was able to do some interviews over the phone. A real highlight was an interview about the show and the technology involved in my procedures with Wired magazine. I now understand websites like “United Airlines (UAL) Sucks” and United Airlines Sucks: UAL Reaches New Heights in Bad Customer Experiences.

The customer service was so bad it would have been funny if it was no so pathetic. I think the low point was a disaster of UAL support from a rep out of India. After explaining the situation he repeatedly tried to switch me to a flight that would arrive after my meeting would be over. I explained that i would not switch to a flight that arrived after my meeting was over so he offered to refund my flight out but explained that there was no way UAL would refund the return flight since it was not cancelled. I explained the absurdity of this to him and how upset I was. He then asked if he met all of my customer service needs (answer – absolutely not) If I was satisfied with the service (answer- absolutely not) and then without missing a beat asks if I would be interested in renting a car through him for my stay in Los Angeles! You can read more about the show in the next post.

Docinthemachine Goes to Hollywood With National Geographic in High Def!

Posted on July 11, 2007 by Steven F. Palter, MD

Docinthemachine is off to Hollywood to speak about my research on HDTV surgery as featured on an upcoming National Geographic show – “Inside the Living Body”.

So much incredibly exciting work has been happening that I wanted to share the details. I have been a champion of high definition TV in medical visualization and surgery since 2000 when I performed the world’s first HDTV endosocpic surgery. Earlier this year I completed some exciting futher developments. We tested the use of the highest definition system ever developed for medicine imaging for the first time in wide screen 16:9 format at 1920X1080 progressive. The folks over at National Geographic got wind of this project and requested footage for an upcoming show “Inside the Living Body” to be broadcast in HD on their HD channel.

I supplied them with footge of all of the internal pelvic and abdominal organs as well as inside the uterus. Thanks goes to my amazing patients fighting to have the opportunity to be the one filmed for the show!

I received a call from them shortly after doing an interview about the work with Wired Magazine (love that mag) asking me to please come to Hollywood for the TCA (Television Critics Association) Convention. Details of the Meeting are here with my show and panel featured at the top of the list (above the Olson twins, Soporanos, Saturday Night Live and All the broadcast hits). I didn’t get listed on the panel since it unclear if my schedule would allow attendance but I won’t hold that against them.

My Panel (plus me):

National Geographic Channel

Inside the Living Body
Incredible Human Machine

Panel to include:
Dr. Steven Zeitels, MD, FACS, Eugene B. Casey Chair of Laryngeal Surgery at Harvard Medical School (HMS) and the Director of the Center for Laryngeal Surgery and Voice Rehabilitation at the Massachusetts General Hospital (MGH)
Dr. Linda Liau, Neurosurgeon and Professor of Neurosurgery at the UCLA School of Medicine; Director of the Comprehensive Brain Tumor Program and director of Neurosurgical Oncology at the UCLA Medical Center in Los Angeles
Stephen Marsh, Ph.D., Cell and Developmental Biology, Executive Producer, Inside the Living Body, Pioneer Productions
Howard Swartz, Executive Producer, National Geographic Channel, Inside the Living Body & Incredible Human Machine

I’m finishing up the posts on the project and the National Geographic Show. I am so excited to have my surgical footage be the first ever HDTV surgical procedure broadcast. As I told them- the viewer in his living room will see views of the human body sharper and clearer than almost any doctor has ever seen in endoscopic surgery. If you were amazed by watching baseball in HDTV and seeing the hairs on the player’s heads wait until you see the amazing clarity of the human internal organs.

Much more to come…

Microsoft Touch Screen – Surgery VR Potential

Posted on July 9, 2007 by Steven F. Palter, MD

There has been a lot in the lay press about microsoft’s new touch tablet display. As CNET writes (video link here):

Microsoft has just announced its Surface Computing technology, a project that has been kept under wraps for five years. Using a giant table-like display, users are able to draw, interact with media, and use another new technology called domino tagging, in which a real-life object on the computer’s surface is identified and becomes an on-screen object that can be interacted with

What is unique about the screen is that it is a collaborative touch table interface. That is, multiple users can interact and manipulate objects. While they claim Microsoft has kept this under wraps for 5 years it is not a new concept at all. Heck, even Minority Report ( my surgical version here) used this concept in its image manipulation scenes.

Last year at Nextfest GE showed a similar protoype and I had an opportunity to speak with the engineer about potential medical applications (he would not let me take a photo of the table they had). It’s best use to date in their mind was for collaborative radiology. However a VERY limited market! I can only see that being used for teaching sessions for trainees (very good in that setting) or for multi-speciality team surgery planning for complex cases (ie conjoined twins etc). Much larger uses will be in military and building and geology.

Could this be a prototype of a gesture control interface for surgery? Noir for real time but more so for planning. I had an extensive discussion of these systems in a late night conference call With Andy Van Dam (you know Computer Science Professor at Brown, Founder of SIGGRAPH, namesake of Andy in Toy Story, invetor of VR and the military Cave technology). Andy feels 100% that surgery should be immersive – that we will be in the image and use gestures to move the images around us. Others disagreee 100%. Many of the the old CAVE researchers (see imersive VR info here)are abandoning that approach for this table like interface. Here you look into the 3-D space and move the object in 3D but NOT immersed. See how much immersion is enough? When I look at a 3D VR travel down the bowel do I want it to look like I am inside the bowel fantastic Voyage style (Andy’s approach) or do I want to stretch it out, slice it open and manipulate the 3D image in front of me twisting and turning it in space (new method)?

Much more on our discussion and the surgical options to follow.