Endoscopes provide an unparalleled view into a patient's body and enable minimally invasive procedures, but they don't work alone. Between the camera that captures images and the monitor that displays the output stands the endoscopy tower, the brains behind the scope. Whether you're equipping new ORs and procedure rooms or replacing the towers your surgeons rely on, you'll want to take the following factors into account.
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An endoscopy tower, also sometimes known as a video tower or an endoscopy or video cart, typically consists of 2 basic components: a light source and a video processor.
The light source generates the illumination that, transmitted to the distal end of the scope by way of a fiber optic cable, enables the camera's visualizations inside of the patient. The video processor receives the electronic signals sent by the camera's light-sensitive semiconductor chip (or chips) and converts them into a visual image that can be projected onto a display monitor.
These 2 engines of endoscopy are typically stacked in the shelves of an upright, mobile stand, although they can be mounted on overhead booms for convenient access by the surgical team.
Besides the display monitor, this tower also usually houses peripheral devices for recording the endoscope's surgical images. Even in this electronic age, printers are still integral to surgical recordkeeping and their photos valuable teaching tools when conferring with a patient and their caregivers after surgery. And a digital video recorder, whether it burns images to a disc or saves them to a hard drive or your electronic medical records system, offers surgeons readily accessible and transferable information.
Advances in vision
When's the right time for a surgical facility to replace its endoscopic imaging system components? It's a question that many administrators have struggled with, and the answer varies depending on your case volume and budget.
But for many, 2 technological advances in the way that endoscopy sees have presented a convincing case for upgrades. Manufacturers claim that high-definition video and contrast enhancement lighting can help your surgeons detect polyps and abnormalities more effectively and perform more precisely targeted biopsies.
Scopes and monitors have in recent years been heavily marketed with these advanced capabilities, but they also apply to the intermediary devices of endo tower systems. As a result, if you're planning to make a switch to high-definition scopes and monitors, you'll have to replace the full suite of electronic equipment that they interact with, including the endo tower, in order to ensure the across-the-board compatibility of higher image resolution specifications and to see the sharper, more detailed pictures that HD video offers. Conversely, if you're selecting an endo tower system with an HD-quality video processor, you'll need HD scopes and monitors to take full advantage of the technological advances.
What contrast enhancement lighting does, in conjunction with HD or standard-definition video systems, is narrow the illumination of the surgical site down to specific wavelength colors of light, as opposed to the full spectrum. This advance in imaging technology is accomplished in one of 2 ways: either through an optical filtering process, where an optical filter actually changes the color of the light that the light source delivers, or through video processing, where the processor mathematically alters the camera's signals to reflect a change in illumination before projecting them on the monitor. The upshot is the ability to identify polyps, diseased tissue and other abnormalities that aren't as visible under plain white light.
HD video and contrast enhancement lighting represent a significant investment if you're looking to purchase an endoscopic system. But the question that many surgeons and administrators find themselves facing is, Can our facility afford not to upgrade to it? Clinical studies on the subject are just beginning to emerge in the medical literature. Anecdotally, though, surgeons say the improved picture quality makes all the difference in diagnosing the pathology of tissue, and its use should not be limited simply to select, high-risk patients.
Standardization or selection?
The components of an endo tower can usually be purchased from the same companies that manufacture the scopes and cameras that are used with them. As a result, the brand of scope that a facility has outfitted itself with is oftentimes an influential factor in a purchasing decision.
There is much logic to support this decision. Purchasing complete endoscopy systems from 1 vendor and standardizing all ORs and procedure rooms with the same models of equipment means that your users will be adept at operating them no matter which room their cases are scheduled in.
Setting up for cases and training staff on the equipment's use are similarly simplified, as are service and maintenance schedules and contacts. Further, in the event that image quality or other operational problems are discovered, troubleshooting will mean less finger-pointing if all the components come from 1 vendor.
Still, many electronic components now feature open architecture, and in a multi-specialty surgical center or hospital outpatient department where general, orthopedic and urological surgeons as well as endo docs use the video equipment, different surgeons may use different scopes.
Make sure that the endo tower system you purchase is "backward compatible" with what you already have. If you're mixing manufacturers, the new video processor, in particular, should have the flexibility to accept the types of image signals that your cameras and scopes produce and be able to communicate them to your monitors.
Conditions of qualification
When you're working with surgeons &#; from whatever specialty &#; to purchase scope-to-video systems, it may be helpful to draw up a grid while trialing to note what the surgeons are asking about, and what the equipment you're considering offers. Here are some of the qualities that may be mentioned.
In addition to delivering good picture quality, a video system should be easy to work with. A wireless video processor can cut down on the number of cables tying your surgical team to the equipment. Speed is also important to surgeons. How quickly does a moving or still image take to get from the camera's activation to the video processor to the display monitor? Do the surgeons sense a delay?
Surgeons will likely want to know what type of bulb the light source employs to generate its illumination. Halogen, xenon and LED bulbs each have a different and distinct brightness and "color temperature," factors that affect how accurately the captured image represents the actual subject. Surgical users may have a preference for 1 type of light over another.
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From a safety standpoint, how much heat does the light source generate, and how hot does the tip of the scope itself get? A misplaced scope tip can burn a hole in a surgical drape, creating the risk of an OR fire. Some light source units automatically shut off as a safety feature if the cable connecting them to the scope is accidentally pulled out.
If peripheral recording devices are going to be part of the purchase, find out how easily surgeons can manipulate still images (can they print four to a page, for instance?) or annotate still images or video (with patients' names, identification numbers, dates of birth, and so on). If the device uses an internal hard drive, what is its capacity? How many cases can be stored? A device with a USB port will let surgeons transfer images to a removable flash drive for portability between the OR and the office.
Additionally, on a practical level, consider the tower's footprint and ease of mobility. Will it fit in among your OR's or your procedure room's other equipment? Can staff move it around the room and your facility's corridors easily and without undue wear and tear?
Pricing and pacing
The amount an endo tower system will drain your budget depends on the components it's configured with and the volume of equipment you're purchasing from the manufacturer (are you buying scopes and cameras, too, or just the support units?). If your facility is allied with a group purchasing organization, the contracts the GPO has negotiated with the manufacturer can secure a discount.
While facilities looking to save some money on equipment purchases often check out the pre-owned and refurbished markets, there isn't much refurbishment activity on the endoscopic video system front. The optimal life expectancy of these components usually isn't much longer than the scopes they support, averaging 5 to 7 years. Plus, given the strides that surgical technology has made in recent decades, surgeons tend to want the latest available advances. Considering these factors and their budget and case volume situations, some facilities lease the equipment to keep current while avoiding weighty upfront costs.
Another decision to be made on a center-by-center basis is whether a facility with the need for more than 1 endo tower should buy them all at once, or stagger the purchases over time. It's an easier question for new facilities, of course: If you've got 4 ORs and have to share 2 towers among them, you'll need to acquire them both at once. But for facilities replacing older equipment, it will depend on case volume, how heavily the systems are used and how frequently they're moved from room to room, and whether you want to referee surgeons' quarrels about who gets to use the newer equipment.
Karl Storz Endoscopy-America
Image 1 HD Endoscopic Video System
(800) 421-
www.ksea.com
List prices: video processor, $25,725; light source, $11,390
FYI: This versatile video platform for minimally invasive surgery is compatible with previous generations of standard-definition cameras and will be able to accommodate the flexible scopes and cameras to be launched in the near future, says Storz. Offering plug-and-play convenience, the Image 1 Capture Module CCU requires no separate unit to print or archive either still images or video, both represented in x progressive scan resolution and a 16:9 aspect ratio. The xenon light source, as well as the insufflation unit, can be conveniently controlled from the camera head within the sterile field.
Olympus America
Evis Exera II 180-System
(800) 645-
www.olympusamerica.com
Price range: $150,000 to $225,000, depending on tower configuration and quantity of scopes purchased
FYI: The Evis Exera delivers HD video and Olympus's proprietary Narrow Band Imaging technologies to provide unparalleled imaging quality, says the company. At 1,080 lines, the HD signal from the CV-180 video processor more than doubles the number of lines scanned by conventional video systems. When used in conjunction with Olympus's HD scopes, the resulting lifelike images offer surgeons clear views of anatomical structures and fine capillary patterns in the mucous membranes. The real-time, on-demand technology of Narrow Band Imaging manipulates the interaction of light and tissue, improving visual contrast on mucosal surfaces during endoscopic observation.
Smith & Nephew Endoscopy
High Definition Endoscopy System
(800) 343-
www.smith-nephew.com
List prices: 660 HD Image Management System, $27,500; 500XL Light Source, $10,650
FYI: Smith & Nephew Endoscopy offers a complete line of high-definition visualization products and services. The 660 HD Image Management System provides powerful, flexible image management to capture, edit, print and store surgical images and video with the touch of a button, and also helps to simplify patient data management. The 500XL Xenon Light Source offers bright, quiet and safe performance, illumination that the company's research has found to be 18% brighter than stand-alone LEDs. Coupled with the company's full HD, 3-chip camera and medical grade LCD monitors, the Smith & Nephew system provides accurate anatomic detail and true color reproduction.
Stryker Endoscopy
WiSe HDTV Surgical Display & Transmitter and L LED Light Source
(800) 435-
www.stryker.com/endoscopy
List prices: not disclosed
FYI: Stryker Endoscopy's WiSe technology combines a 26-inch, p, flat-panel monitor with a wireless HD video transmitter. The result is surgical images with high resolution, brightness and optical clarity, presented without the clutter of video input cables and with the freedom to move the display monitor anywhere in the OR. Secure and exclusive transmission channels protect image signals from interference from other medical equipment in the OR. The light-emitting diode bulbs in the L LED Light Source mean a cooler, more energy-efficient light, fewer bulb changes and less waste. Its output settings are completely controllable from Stryker's HD 3-Chip Camera.
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