A novel telemedicine method for viewing the open surgical field.

Abstract

The surgical theater has undergone a series of transformations from an open stadium-like environment to the closed environment of minimally invasive endoscopic surgery. Paradoxically, evolution from open surgery performed under direct vision to closed surgery performed through use of video images has been accompanied by improved viewing of the operative field by student observers. The objective of these experiments was to determine if a laparoscope mounted on the operating table during open surgery would provide students a better view of the operative field than that provided while standing behind the operating surgeon or via an optimally positioned hand-held video camera. An endoscopic video camera and telescope were attached to an operating table by an Alpha Virtual Port, which facilitates use of the laparoscope in open surgery by fixing it to the operating table in the position of interest. Additional imaging systems were set up so as to simulate viewing of the surgical field by direct vision or a hand-held video camera. Common objects were placed on the operating table in mock surgical fields of various depth-to-aperture ratios. Images of these surgical fields were obtained by each of these systems and placed in a Web-based tool. Eleven people with a wide range of medical training evaluated the images and determined that the Alpha Port-mounted surgical telescope provided optimal visibility of the mock open surgical field. The benefit of use of the mounted telescope was more pronounced as the depth-to-aperture ratio of the surgical field increased. Use of the Alpha Port-mounted laparoscope in open surgical procedures improves student viewing of the open surgical field.