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PROF. SREEJOY PATNAIKSHANTI OMNI SUPER SPECIALITY
HOSPITAL , CUTTACK ,ODISHA
ENDO-VISION SYSTEM IT’S MAINTANENCE AND
TROUBLE SHOOTING
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EVERY SURGEON SHOULD KNOW THESE BASICS PRIOR TO STARTING A LAP. UNIT
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ENDOVISION SYSTEM-‘EYE OF THE SURGEON’
• Revolution in optics & imaging technology helps to produce real ‘life like’ images in a magnified way, thereby helping accurate dissection.
• ELECTRONIC EYE INSIDE THE ABDOMEN
• The imaging system includes-– Laparoscope / Telescopes– Light source– Light cable– Cameras– Monitors
• For a ‘perfect image’ all of them should be of good quality.• A GOOD ENDOVISION IMPROVES THE QUALITY
& PRECISION OF SURGERY & ITS OUTCOMES.
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THE ENDOVISION EQUIPMENTSTHE ARMAMENTERIUM
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1.LAPAROSCOPE OR TELESCOPE
• Invented by Hopkins in 1953 Rod Lens system.• Present day laparoscopes - series of rod lenses in
centre with a rim of optical fibers on the outer aspect.• Optical fibers carry light into the abdominal cavity &
rod lens system transmits the image from abdomen to the camera.
• From the camera (attached to the proximal end or eye piece of the scope) the images are displayed on to a monitor.
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CONVENTIONAL VS OPTICAL LENSES
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A TYPICAL ROD LENS SYSTEM
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LAPAROSCOPES( TELESCOPES)
Laparoscope may vary in size ( dia.)
Size 0.8mm - (Needlescope) to 15 mm in dia.
Angle of vision - 0° /30°/ 45°, 70. 0 & 120
Rigid, flexible or semi flexible
Brightness of the image reduces with the size of the scope
The angled scopes 30° / 45° provide
Flexible field of vision.
Unobstructed view from distance
More space for maneuverability of instruments
Ability to look around the corners
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Normal Hopkins Forward Oblique Scope -300
Diameter – 10 mmLength - 33 cmExtra Long – 43 cmAutoclavable
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SEMI FLEXIBLE – TIP OF THE SCOPE [ SILS ]
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2. CAMERA SYSTEM
• It is the most important and vital part of the imaging system and should be of good quality.
• It consists of 2 parts-• Camera head connects to the prox. End or eye
piece of the laparoscope.• Camera Microprocessor unit which receives,
processes and transmits the pictures to monitor.
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Requirement of Cameras
Camera Specifications
Three important Features 1.Horizontal Resolution2.Minimum Luminance 3.Signal to Noise Ratio
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Horizontal Resolution (lines)
It is a measure that shows to what extent details can be distinguished on the monitor.
It can be evaluated by establishing the limits to which lines can be distinguished on a test pattern.
A larger resolution value means a broader frequency band of the video signal.
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Minimum Luminance (lux)
It is a measure that shows to how sensitive the camera can produce a good picture.
It is measured in lux or footcandle unit.
1 Footcandle = 10 lux
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Signal to Noise Ratio (dB)
An S/N ratio is noise to actual total video signal
It shows how much higher the signal level is to the level of noise
It is expressed in decibels (dB)
Bigger the value - better the picture
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Features of Cameras
Horizontal resolution (lines)Higher ---------> Better
Minimum luminance (lux)Higher ---------> Worse
Signal to noise ratio (dB)Higher ---------> Better
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CAMERA SYSTEM
• Resolution of the camera directly proportionate to the no. of pixels.
• Presently CCD cameras used – consists of tiny bits of silicon (divided into multiple tiny sensors) called ‘pixels.’These are arranged in rows & columns and are sensitive to light.
• When light strikes a pixel, the silicon emits electricity, that is transmitted to the monitor.
• Electronic signals are sensed to provide the recording image.
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The resolution from the CCD is dependent upon the quantity of the pixels on the sensor.
The resolution is defined as the amount of vertical lines that may be discriminated separately in 3 quarters from the width of the monitor screen.
The lap. Camera requires at a min. 300 lines of resolution to supply a sufficient image.
CAMERA SYSTEM - RESOLUTION
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TODAY’S LAPAROSCOPIC CAMERAS
Available in Single or 3 Chip
We all know the 3 Primary colours– R / G / B
All the colours are a mixture of these 3 Primary Colours in different proportion.
Single Chip- All 3 primary colours are sensed by a single or 1 chip.
Three Chip- CCD- chips separately sense, capture and as well as process the Primary colours.
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TYPES OF CAMERA SYSTEMS
1. SINGLE CHIP
2. THREE CHIP OR CCD
3. HIGH DEFINITION
4. 3D
5. ROBOTIC PLATFORM
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SINGLE CHIP CAMERA– Multiple color sensors provided
in a single chip providing a single image
– Monitor resolution needed is usually 400 – 600 lines.
– Adequate for routine basic surgeries.
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Single Chip Camera
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3- CHIP CAMERA– In 1989 , the field of surgery experienced a revolution in
the form of ‘Laparoscopic surgery ’ with the introduction of CCD cameras (charged couple devices) and better light sources.
– Captures light in its 3 components– Unified light slit into its components ‘ red, green, &
blue’(RGB) by prism located in head of the camera– Signals are then captured by separate CCD’s containing
multiple sensors & are processed and sent to monitor.– Currently available cameras have ability of producing
videos of resolution of 950 lines i.e. ‘high quality images’.
– Great help in advanced lap surgeries.
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HD CAMERA
• The latest generation of cameras are high definition cameras• They produce the resolution of 1080 horizontal lines per inch.• Require HD monitors to reproduce the same quality of picture• Offers a superior image with a wide, more natural 16:9 format
and 1080p resolution for FULL HD with 2 million pixels.• That is the highest resolution in the medical industry.
• At present it is very costly.
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HD CAMERA & IMAGING
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4 Types of Video Camera Outputs
1.RGBComponent signal
2.S-VHS or Y/CComponent signalChrominance & Luminance (color & light)
3.Composite video signal or BNC -- All components of the picture combined into one video signal
4.Digital Signals
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3 - D CAMERAS
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POLARISATION GOGGLES
3 D MONITORCAMERA HEAD WITH PROCESSOR
DUAL CHANNELTELESCOPES
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The human brain combines two images to one 3D impression
BINOCULAR EFFECT-WORKING PRINCIPLE
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5-8 % of humans don‘t have the binocular effect
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STANDARD 2D- EFFECT
CCU
Camera Head Object2D Endoscope
(one channel)
Sensor
2D HD Monitor (1080 lines x 1920 pixels)
one image (all lines/pixels can be seen with both eyes)
left Eye
right Eye
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THE 3D- EFFECT
CCU
Camera Head Object
Dual Channel Endoscope
Sensor 1
Sensor 2
Sterile Adapter
3D Full HD 32“ Monitor Odd lines (line 1,3,5,7…)
even lines (line 2,4,6,8…)Polarisation Glasses
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Polarisation filter
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Dual channel endoscope creates two live-images
Camera head has two sensors
Flat screen has a polaristion filter and shows two images simultaneously
Even-numbered-lines on screen (2,4,6….) show image 1
Odd-numbered-lines on screen (1,3,5 ….) show image 2
Polarisation glasses select from image 1to (right eye) from image 2 to (left eye)
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THE POLARISATION EFFECT
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Circular polarising glasses separate the two images in front of the eye:
- the even lines can be seen only with the right eye
- the odd lines can be seen only with the left eye
The human brain receives a true 3D impression from flat display
The displayed object seems to grow out of the flat screen
The surgeon gets a true depth percecption
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Stereoscopic visual effect
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Restores the surgeon’s natural 3D vision and depth perception.
Provides depth cues and precise spatial orientation
Shown to enhance dissection, grasping skills, suturing, stapling and overall surgical efficiency.( Correct picking up of delicate tissues & exact positioning of needles.)
Requires no additional certification or training for those surgeons certified to perform laparoscopic procedures.
Reduced learning curve for young surgeons.
Enhances task performance leading to lower procedure times and costs.
*data on file
Benefits of
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Cameras -Advantages & Disadvantages• All cameras need
– White balancing
– Focus – manual / auto• Some cameras have options of
– Zooming – useful for finer dissection
– Digital enhancement – provides sharper images .
– Disadvantages – development of grains which may distort
– image quality• HD cameras
– Provide stereoscopic vision
– Costly & no clear cut advantage over existing cameras
3D Cameras ( Disadvantages )
– No optical zoom
– Scope not rotatable
– Presently scope available only as 10 mm & 00
- Wearing of Polarisation glasses
- Costly
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FLUORESCENCE IMAGING SYSTEM STORZ
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NIR/ ICG – FLUORESCENCE IMAGING
Near Infra Red & Indo Cyanine Green enables non-radioactive visualization of the entire lymphatic system surrounding a tumor in real time.Advtg:1. Non- radio active LN detection2. Multi disciplinary use – Gyaenecology, Surgery ,
Urology3. Easy switch over from standard to fluorescence
mode by a foot switch.4. Accuracy in en-bloc dissection during radical
lymphadenectomy
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3.LIGHT SOURCES
• Thanks to Edison for inventing the Electric Bulb.
• MAS depends on artificial light to inspect the closed body cavity.
• Quality of Image obtained depends on the quantity of light at each step of Opto-Electronic system.
• Essential vital equipment for producing images.
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1.Halogen ( Quartz) Highly efficient, Halogen Gas is used, excellent colour
rendering.Gives yellow coloured light.Economical. .Sufficient for Basic Lap. Surgeries.Available in 150 watts.Colour temp.- 5000-6000KAv. Life- 2000 hrs.
2.Metal Halide-Mix of a compound ( Rare salts of the earth +
Halides)Ex; Iron & Gallium Iodide Lamp .Provides high intensity heat alongwith brighter light.
250 W. Av. Life- 250 hrs.
TYPES OF LIGHT SOURCES
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3.Xenon-Consists of quartz glass ( high grade fused silica)But cold white light, its tip generate considerable heat, so direct contact with the internal organs to be avoided. Better visual clarity175/300 watts, approx. life of bulb 500 hrsColour temp: 6000-6400 kSlightly Costly Av. Life – 500 hrsNatural white light
4.LED-
TYPES OF LIGHT SOURCES
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PARTS OF THE LIGHT SOURCE
1. Lamp / Bulb
2. 2.Heat Filter
3. 3.Condensing Lens
4. Manual/ Auto Intensity Control Unit
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1. LAMP:
Most important part .Quality depends on the type of lamp used.
2. HEAT FILTEREnergy consumption of a Normal light source98% heat / 2% light.Filter reduces the heat & provides a cool light as heat gets dissipated during transportation along the cable and the telescope.
3. CONDENSING LENS:Converges light emitted by the lamp to the area of the light cable input to the scope.It increases the light intensity per sq m area
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4.MANUAL/ AUTO INTENSITY CONTROL CIRCUIT
All light sources – in built circuit to adjust light intensity either manually by the surgeon or automatically ( newer L S)
This AGC ( Auto Gain Control) of light source works synchronously with the advanced camera systems.
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4.LIGHT CABLES• Working Principle- light conducted through a curved
glass rod by total multiple internal reflections, from one end to other end of the cable .
1. Fiber optic cables – more user friendly consists of bundles of glass fibers, thread swaged at both ends.
Size of fibres- 10- 25 mm dia. High quality transm. Disdv—fragile, breaks at bends ( dark spots ) 2 Fluid filled cables
– Made of liq. Crystal gel, swaged at both ends.– Transmits more light – 30% more.– Disadvantages – stiff , fragile, cannot be autoclaved Conducts more heat - Use – Movies / TV as LCD /Photography
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Light Cable
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4. MONITORS
• Final limb of imaging chain• Quality of monitor essential for adequate quality of
image• If monitor does not support resolution of camera, then
all the advantages of using high end camera is lost.• Principle-Horizontal linear scanning on the face of the
picture tube.Each picture frame consists of several lines depending on the type of system used.
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Final image on the Monitor depends on:
1. No. of lines of Resolution – denotes No.of B&W lines both vertical & horizontal.
2. Pixels – denotes picture elements & details3. Dot Pitch – denotes a restricting factor & represents the
phosphor element size.
INPUT CABLES INTO THE MONITOR4. Composite- Video- via a BNC connector5. Y/C or S- Video- via a 4-pin DIN connector.6. RGB Video – via a multi head BNC cable connector.7. DVI input- compatible to HD monitor / flat panel.8. HDMI Input Lap. Cameras supports 1 & 2 above.
New flat panel TV support – RGB input No.3
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Monitor - Compatibility with Cameras
• Monitors with resolution of 600 lines for single chip , > 900 lines for three chip & 1080 and above for HD for optimal resolution are required
• High end analog digital and HD flat panel monitors are now available, – they can be placed at more ergonomically viable
positions, – avoid various head, neck, shoulder ailments in Lap
surgeons
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Monitors
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HD MONITORS
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Maintenance
• Light Cable – Handle with care. Do not twist.• Outer surface should be cleaned with mild detergent. • Periodical cleaning with moist alcohol swabs. • Avoid pt. burns under drapes.• Light Source-• Xenon bulb has life of 500 hrs.- Change bulb if intensity of light decreases.- Don’t cover light source while working- excess heating can cause
damage to it- Periodical check of Light source exhaust fan.
*****DO NOT SEARCH FOR THE BIOMEDICAL STAFF, TRY TO LEARN AND SOLVE IT YOURSELF.
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MaintainenceTelescopes-
-Avoid any thermal or mechanical injury to tip of telescope.
- Clean the eye piece, light cable slot and tip with warm water. - Chemical sterilization with Glutaldehyde or Cidex solution is
done. Few scopes are autoclavable
Camera head- -Avoid any injury to camera head and its cable. - Camera cover should be used to avoid contamination of
operating field.
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Trouble shooting
• Poor picture quality may be due to- Fogging of scopes
– It is a big problem– Gives a dull & hazy image– Warm water/ betadine soaked gauze / anti fog soln. are
used to clean the telescope lens*[Connecting the insufflations tube to the optical trocar
and passage of cold CO2 causes more fogging]
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Trouble shooting• Poor picture quality – needs cleaning of scope tips and
camera head.Flickering electrical interface -caused by loose connection.
- Moisture in camera cable connecting plug - dry it with the help of drier
- Poor cable shielding - replace cables- Insecure connections - reattach cables• Blurring or Distortion of picture is due to incorrect focus
- adjust camera focus- Cracked lens internal moisture - replace scope
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Trouble shooting
-Inadequate Lighting may be - caused by loose connection of light cable at source or with scope - Adjust connector light on- man. to auto. - Bulb is burnt out- replace the bulb.- Fiber optic cable are damaged - replace light
cable.- Monitor brightness turned down- adjust settings.
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Trouble shooting
-Light is too bright -Light is on manual max- turn on to auto mode. -Light boost activated- deactivate boost -Monitor brightness up- readjust -White balancing is mandatory for obtaining
natural colour – target against a white object.
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Troubleshooting-
• No Picture on Monitor-- Camera control unit or other components are
not on - check power supply to all the units and turn on power.
- Cable connection between camera head to camera control unit and/or monitor is not attached properly - check all connections.
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White Balancing
Warm up the light source
Gain in STANDARD position
Fill monitor with white surface
Focus so threads are visible (no glare)
Depress WHITE BALANCE for 3 sec.
Hold image steady on white surface until the tint on the monitor stabilizes for 2 sec.
OR DEPRESS THE REMOTE ON THE CAMERA HEAD
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BEST BUY FOR A LAP SET1.Reputation of the Company2.After sales and service ( Locality/ state )3. List of installations ( Add / Contact No. )4.Check in the Internet.5.Ask for Demo for 2 weeks.6.Ask for Invoice/ Quotation of supplied or cheques received7.Bargain for the best price..8.Ask for a Package.( Hand instrument set)9. Ask for an extended warranty.10. Lastly, ask for supply on a rental basis/ Payments in Installments.
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