April 2001

Watching the Body

Endoscopic HDTV gives surgeons better vision.

By Marc Wortman

Consumers have been slow to buy into high-definition television (HDTV) despite the technology's promise of sharper, brighter images. Now the makers of a prototype HDTV system are looking for a better reception from an audience a bit more demanding than your average couch potato: surgeons. The hope is that using the technology in endoscopic surgery could lead to quicker, more accurate surgeries with fewer complications.

Endoscopes allow surgeons to see into the body to perform complex surgical procedures, from repairing joints to removing cancerous lesions, through tiny incisions. Each endoscope has a thin tubular protrusion that can be threaded through the incision; the tube houses lenses or optical fibers that feed images from inside the body to an eyepiece, or to a camera that relays the picture to a monitor. Although surgeons perform hundreds of thousands of such procedures every year in the United States alone, they often lament the poor quality of video due to blurring and transmission artifacts.

Steven F. Palter, a surgeon at the Yale University School of Medicine, spurred electronics giant JVC to join with San Ramon, CA, medical optics company TTI Medical to make a mini-HDTV camera for endoscopic surgery. Recently, JVC developed a palm-sized HDTV camera-the world's smallest-for microsurgery on tiny blood vessels and nerves. The next challenge was adapting the camera to an endoscopic viewing system.

With 1125 scanning lines, compared to the 525 lines offered by current video standards, the surgical images derived from the HDTV system had more than twice the resolution, and the digital processing of the signal eliminated almost all visual artifacts. "It's like looking with your naked eye into the body," says Palter, who has successfully used the system in five procedures so far.

The potential benefit is not simply a clearer picture but a vastly improved perception of detail. Surgeons will be able to more readily distinguish between normal and abnormal tissue, and to conduct operations requiring fine dissection more accurately. "There are areas that could not be seen with a traditional video system that you can clearly see with HDTV," says Jay M. Cooper, a Phoenix gynecologist and president of the American Association of Gynecologic Laparoscopists. "I see potential for dramatic improvements in what we can offer our patients." JVC and TTI Medical are working to make the camera smaller still, with improved sensitivity and easier sterilization. They expect it to be commercially available by the end of the year.