II) Video Management (VM) for operating theatres: Is there a standard need?

March 2021
Hervé K. - Xavier P. - Jagoda G.

Part 2: Involve all stakeholders and choose the solution

How not to make a mistake in choosing a Video Management (VM) solution? In Part 1 of this article we covered the key elements of building a VM project. In this second part, we will share with you our feedback on the actors involved in the project: their profile, their needs and their impact.

Include the surgical team very early in the project

In order to have a clear and fair vision of the VM need, it is necessary to dialogue with all the stakeholders of the project (surgeon, manager, nurse, anesthetist,computer scientist, etc.). This step, even if tedious, is essential to choose asolution that is ergonomic, appreciated and therefore used daily to the maximum of its potential and its functionalities.

Your goal is for it to be adopted quickly and for you not to hear about it again: "No news, good news". It is therefore fundamental to identify everyone's expectations, fears and questions very early in the project, in order to be able to integrate them into the final solution.


In the case of surgeons, they generally go very quickly over the machine and get a quick and sometimes subjective picture of the system and all of its capabilities. They will base their judgment on criteria such as the design / look of thedevice, the brand and some technical qualities. In the majority of cases, they do not have to manipulate the system. What will interest them more is how they will be able to record their videos? How will they be able to recover them? Will they be able to lecture in an amphitheater from the operating room? So many concerns to which we must find a simple answer.


The OR nurses, ward assistants, are the "real" users of the system. Often they are only called upon once the choice of solution has been made. They should be included much earlier, from the machine demonstration phase to see their first reactions, the way in which they appropriate it, the questions and remarks that the interface arouses in them. After all, they are the ones who are going to manipulate it. The nurse who will use it on a daily basis is above all looking for peace of mind: knowing how to use the machine quickly and access essential functions with just one click, intuitively. In addition, he will be sensitive to reliability and it will be important for him to easily identify the source of a malfunction if it occurs.

IT specialists

Finally, IT people are very sensitive about cyber security. With the arrival of increasingly demanding standards, they are the guarantors of the safety of patient data conveyed within the establishment. They ask themselves a lot of technical questions and seek clear, precise and relevant answers in relation to the infrastructure for which they are responsible. Hence the importance of redirecting them to an interlocutor or document that provides them with effective information. It is still not quite natural for the IT department to go down to the operating room. Indeed, it has been relatively new that computer scientists have been closely concerned by all these questions relating to the surgical environment. Today, ubiquitous technology has changed the game and they are essential and intervene from the definition of the VM project on the sizing of the infrastructure: computer access to the operating room, to patient data, the speed of data exchange, the functioning of the establishment's network and finally the safety of the machines.

Dialogue on immediate AND future need

Let’s tackle an important topic here, which is scalability and backward compatibility. Particularly in the VM sector, scalability is THE HOT TOPIC that is at the center of biomedical concerns in a new project. In fact, no one wants to invest a large amount of money in new equipment, depreciable over 5 to 10years, when it can become obsolete after two years.

Our advice

The advice we want to give here is to anticipate, when choosing your VM solution, what you will want to connect to it in the future. In short, take the crystal ball!

This is far from a bad joke. Why are you being told this? Because not every need can be scalable without leading to a significant change of material.

There are certain needs that can be met by a simple software modification or by adding asimple independent hardware module (eg: updating my Windows 7 system to Windows10 or adding an SDI to HDMI signal converter). But there are also needs which relate in particular to technological development, connection capacities and other functionalities which require the replacement of an entire system (e.g.compatibility of a FullHD system with 4K / 3D sources).

We are aware of the difficulty of the thing. As a manufacturer, we are also impacted by developments and must constantly test and validate in order to adapt. Indeed, the products and technological components of equipment suppliers having an increasingly shorter lifespan, we must ensure the compatibility and durability of the equipment we offer.

Reverse logic

Note that this is not without consequences on your initial budget. We can offer a solution at the fairest price for your current needs. But the price of the solution that will also meet your future needs is often more expensive initially, but more profitable in the long term.

Indeed: If you have Full HD sources, ask yourself if in a year or more you will have to change them to 4K by purchasing new equipment such as an endoscopy column exclusively in 4K for example. If this is the case, you must opt ​​from the start for a VM system capable of capturing, routing all sources up to 4K, while being compatible with Full HD often offered for recording. Of course, you will pay more up front, but you can easily connect your future 4K column without additional expense. Conversely, "upgrading your Full HD system" may involve hardware changes such as it feels like you are paying for a new system.

Evolution and wiring

In our field, what is subject to change is mainly cabling and it is often limits or guarantees this famous"scalability". For several years now, we have noticed special attention paid to cabling in calls for tenders. Details and specific requests related to a technology to ensure future scalability: what does this mean? Quite simply, biomedical engineers want to make sure that they are investing in an infrastructure that will not move at least for 10, 15 or even 20 years. And that when they modernize their equipment on the block, they do not have to redo all the connections and all the cabling. In fact, the down time of operating rooms during the work and deployment of these solutions has a significant impact on the overall organization of the operating room, for both staff and patients. And what they want to avoid at all costs is further loss of business.

To conclude, choosing a VM system requires having a global vision of the project. This vision is built by bringing together the constraints, real needs, expectations, wishes, and perceptions of each stakeholder in this project,while anticipating future needs.

Equipment level and cost

First, second, third level

In order to set up VM in your establishment, there are no prerequisites in terms of infrastructure or technology for the first level of equipment. In other words,we can install VM in any hospital or clinic without difficulty, regardless of its existing equipment and the age of the premises. It will all be a matter of cabling, connections and a server for data storage, if there is one.

For the second and third level, the establishment must equip itself with a solid and efficient network infrastructure to ensure optimal functioning of the communication (transfer, streaming and / or videoconference).

Indeed, when you equip an operating room for training, it is essential to offer an image quality at least equivalent to what the students could perceive if they were present "physically" in the room, in other words, if they "saw with their own eyes". We must not induce loss of information, poorly retransmitted or choppy surgical procedures, due to a bad network with insufficient bandwidth.


Obviously, the technology will not replace the eyes of the students, but the idea is to guarantee sufficient quality through a definition associated with a good fluidity of the display.


80% of the price of your VM must be used to finance the basic options: capture, route and display sources. The investment includes the purchase of equipment (controlunit, monitors, cables and connectors) and the cost of engineering and project management. The "record and archive, communicate" functionalities rely heavily on your existing equipment and infrastructure and the additional purchase of software.

What should be remembered from this part is that a VM project concerns a growing number of people. It is also a project that is conceived in a holistic manner and is part of a strategic policy of the health establishment. Although the scale of the investment and the work vary from one project to another, the impact in terms of the establishment's image and reputation is significant. What hospitals are looking for by equipping themselves with a VM system is above all an image of modernity. The challenge is to reassure patients, but also to attract new talents increasingly conqueredby digitalization.


Choose the solution

The observation of the standard need

Each project has a solution. However, for 20 years we have been working in the VM sector in France and for more than 10 years internationally, and we have seen a standard or minimum need emerge.

Faced with this observation, our development team designed a product that meets this minimum need in order to easily adapt to all situations, regardless of the progress of the site's work. Thus, we have developed the SurgiMedia XL.

A product that synthesizes all the needs and constraints mentioned, by adapting to all the standard requirements of operating theaters. Proven since 2016, it has been installed in establishments such as the Necker AP-HP Hospital (Paris), the Saint Antoine Clinic (Nice), the Saint Vincent Clinic (Réunion), the CHR Metz-Thionville (Ars-Laquenexy), Wroclaw University Hospital (Poland) and many others.

LucFagot, Biomedical Engineer at Clinifutur testifies:

"What I like about the SurgiMedia XL is the fact that it is a vendor-neutral solution. I also appreciate its capacity to connect multiple video sources, its intuitive interface and its ability to fit customer’s needs."

By consulting the SurgiMedia XL product sales brochure, you can easily see if the product matches your project. If, however, this was not the case, ISIS offers a wide range of solutions for the operating room.

SurgiMedia XL installed at the Saint Vincent Clinic on Reunion Island.
SurgiMediaXL installed at the Saint Vincent Clinic on Reunion Island.

Turnkey block VS independent suppliers

For some buyers, it is preferable to only communicate with a single interlocutor capable of providing all the medical equipment in the operating room (surgeon arms, anesthesia arms, operating lights with or without a camera, operating tables,VM). The purchase of this type of "turnkey" block, even if it brings a certain serenity to the buyer by relieving him of the project management of his project, can prove to be more expensive in the end, without the exempt from important upstream choices described in Part 1.

The independent supplier specializing in VM, sometimes associated with a single partner, is therefore the other purchasing solution, allowing a "tailor-made" response to these various constraints.

Of course, the management of the project is the responsibility of the biomedical managers, and this may frighten some. But in reality, we often think of these VM systems last, which forces us to constantly adapt to the various stakeholders who come upstream of the project and who equip the room with arms, lighting, tables,etc. We must interface and dialogue with several trades, whether they are external (imagers, manufacturer of lighting, arms, tables, etc.) or internal to the establishment (electricians, technical and IT services, etc.), and of course we have become specialists!

Very often, for independent projects, our partners and ourselves become the prime contractor, and intervene directly on site to coordinate the site in connection with our equipment.

Thus, calling on an independent supplier is not insurmountable. On the contrary, it often brings more flexibility and agility to your project, not to mention themore advantageous financial aspect.


To the initial question which was "is there a standard need?" » we can answer YES, without hesitation. This minimum requirement remains constant over time and does not seem to be affectedby technological developments. The functionalities (route, display, record,etc.) and the desired capacities (number of video sources, number of monitors) do not change. Finally, it is in terms of comfort that technological changes have the most impact, visual and ergonomic comfort which is specific to each surgical team and depends on the way in which each wishes to work. Hence the importance of building the project very early on with all team members and integrating IT contacts, who ensure that these VM requirements are optimally integrated into a high-performance and secure infrastructure. Finally, everything is a matter of balancing the requirements of the team and the budgets granted by the establishment. SurgiMedia solutions exist for all projects and for all budgets, you just need to know exactly what you want!

Want to know more about the SurgiMedia XL functionalities?
Click here to download the brochure.