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

March 2021
Hervé KOEHL, Xavier PRIQUEL and Jagoda GORNICKA

Part 1: Identify the real need

Today hospitals, and in particular operating theaters, have become hubs of innovation. There is a real proliferation of solutions, functions and various technologies, with manufacturers, resellers or suppliers offering tailor-made and sometimes scalable solutions. These solutions are often captive and proprietary and do not always allow you to compose your own solution from selected elements.

Some of our biomedical engineer clients say they feel pressured, confused by the never-ending race for innovation: "Do I really need the latest technology? How do I differentiate the technology gadget from what is really necessary?"

A great responsibility rests on their shoulders: a significant investment and in the background, the fear of making the wrong choice of product (not adapted to a dedicated or multidisciplinary environment, not used daily, or that become obsolete quickly) AND of company. Because advice and support count a lot in the end result and in the long term.

So how do you make the right choice? What is sufficient? How to distinguish between the real need and the gadget?

In this article we will give you the keys to understand and the right questions to ask yourself to avoid losing ground.

Video Management (VM):  Video? Yes, but not only!

Generally, when we read “video management”, behind this word, we put everything related to the video in the operating room, namely video sources (endoscopes, microscopes, the C-Arm, etc.) and monitors to display them. This is partly correct. What we often forget to relate to it is the information and images coming from the computer network and most often coming from the X-ray image servers.


So, how has IT become an essential link in understanding VM today?



To answer that, let's go back a few years backwards. 50-100 years ago, the surgeon operated only "by sight" and was all alone to see what he saw, directly or through dedicated microscope-type accessories and / or with endoscopes. These tools, then associated with the first cameras, introduced increasingly "flat" screens in the operating rooms: he was no longer the only one to see what he was seeing. He could share it with his team, which consisted mainly of his assistant and a nurse.

To keep track of his intervention, he solicited the biomedical engineer for the purchase of a VCR or a printer. These complementary (not always medical) devices were generally supplied by the manufacturers of endoscopy columns. But what one could notice at this point was the fact that the surgeon was the sole user and managed his display, photos and videos on his own.

This practice having multiplied and developed over the years, the problem of patient data security began to arise through mobile storage devices (CD-ROM, USB, external hard drive, etc.) "wandering" in the corridors of the establishment and sometimes even outside, with data that was not systematically referenced. Thus, to ensure a minimum of security, hospitals wanted to establish traceability with the centralization of data so that they are automatically attached to the patient and to prevent them from being lost. To do this, IT, already being deployed in all the other departments of the hospital, was therefore implemented in the operating room.


Medical imaging

Another significant development in surgical practices has brought IT closer to operating theaters: the digitization of X-ray images and preoperative scans. This data, initially used for diagnostic purposes, was centralized and then made available to interconnected users. This effectively established a physical link between the previously isolated operating room and the rest of the hospital, allowing access to PACS images.

Use of printed X-ray images hung on the operating roomwall.

In short, the growing practices of video management (generating images and videos in the room) have reinforced the need for the operating room to connect with the rest of the establishment. A connection made by and thanks to computers.


Interaction between biomedical and computer scientists

And if the VM is not limited to that, it still seemed important to mention the IT part. We often observe, in the various projects that we lead, a lack of proximity between the biomedical and IT departments, a proximity that is nevertheless essential and necessary for the success of your project.


So, if we come back to the question of this article, today the basic need for video management has become the interaction of the operating room with the rest of the hospital. This need is the basic foundation that allows the various features of the VM to be expressed: it is in fact a prerequisite.

Functionality spectrum

Connecting the operating room to the rest of the establishment has therefore been and still is a real "revolution" for hospitals and clinics, making it possible to respond to the issue of patient data security via IT. But not only. Computing has opened up a whole new world of possibilities for video management.

Understanding a minimum need for video management goes through the essential questioning of the purposes of this video in the operating room: what should the images displayed, recorded, shared in the operating room be used for?!

These questions correspond to specific needs, different actors and intervene at different times during the surgery.

3 gradual levels of equipment

1. First level:

It corresponds to the need to"visualize" pre and intraoperative information, mainly images, from different computer sources and videos, displayed in different places in the operating room.

These data are mainly used before, in consultation, and during surgery. Although they are generated directly to optimize surgery, they are also very useful for other members of the surgical team: the assistant, nurses, scrub nurse and anesthesiologist. Indeed, they are a source of information for the team that allows everyone to anticipate their action as the surgery progresses. This brings a high level of comfort and serenity.

2. Second level:

It corresponds to the need to "save /store / archive" photos and videos generated "LIVE", during the surgery.

These are recording functions for “after-surgery” use, which mainly benefit the surgeon for the enrichment of the patient file, for training, and / or for the administrative process of the hospital to ensure a certain traceability.

Convert and archive in a specific format (DICOM), which cannot be accessible and usable "by everyone", adds an additional level of data security, which is mandatory in some countries but not yet in France.

3. Third level:

It corresponds to a need for "communication". These sharing functions (videoconferencing and / or streaming mode) are used during surgery by the operator for "LIVE" communication with interlocutors located outside the operating room, on the same site or on a remote site.

Whether it is giving courses to students or exchanging occasionally with colleagues, this "collaborative mode" is a growing demand nowadays, allowing hospitals to de-clutter operating theaters, while maintaining an equivalent level of information transmitted, or even higher, and guaranteeing compliance with controlled hygiene.

Operation shared in streaming from the OR.

Two observations

- IT is now involved in every step of the surgery. Whether it is upstream of this to consult and sometimes import the patient data available on the hospital server,to exchange in collaborative mode during the surgery, to simply store the images taken during the surgery on the hospital's servers. PACS type and / orto secure / encapsulate them in DICOM format.

- The surgeon is no longer the only decision-maker involved: the VM is indeed a tool at the service of the entire surgical team.

Define your need

Before choosing your level of equipment (1, 2 or 3) in VM you should ask yourself a number of questions about the project and its implementation. In general, they boildown to 4 subjects:

- The dimension of the project,

- Change management,

- The technical aspect,

- The ergonomic aspect.

The dimension of the project

As a biomedical engineer your first concern will be: "How big is my project?". Is it a renovation of one or more rooms, or the construction of a new technical block / platform?

Do you want your rooms to be up and running quickly to maintain operating activity and limit operating loss, or do you have sufficient time?

Is your objective to "redo everything" (floors, partitions, weak current, networks, new equipment) or on the contrary, you have constraints, you can only "put back a lick of paint" and take advantage to modernize the equipment of the block?

How far do you want / can you go in your project?

There is asolution for each project, it is still necessary to define it.

Change management

When you renovate or build an operating theatre, you are going to make changes and therefore shake up the habits of the surgical team: this is when the human factor comes into play.

The idea at this stage is therefore to try to measure the degree of change that you are going to introduce in this project.

Naturally, when you build a new OT, you will tend to start from scratch and introduce a lot of changes with new material, new ways of doing things, etc. This change can be well experienced, understood and accepted.

However, when it comes to a renovation, resistance to change can be felt. You're going to have to deal with the old way of working with older tools too. Example: eliminating the use of USB and forcing staff to go through the machine and the network to identify the patient and record images and videos on the PACS or other server from the operating room.

The technical aspect

In your needs analysis, you will ask yourself if you want to reuse all or part of the existing equipment, or even throw it all out.

If you decide to keep the equipment, you will have to ask yourself how old this equipment is and what will be its degree of compatibility (i.e. type and nature of signals) with the contribution of new technologies in VM?

Indeed, one of the challenges for the VM sector is to guarantee multi-brand and multi-signal compatibility, and there is still a significant heterogeneity of medical equipment, both in terms of manufacturers and the types and formats of signals used. As technology has evolved very quickly, different types of signals coexist.

The ergonomic aspect

The ergonomic ideal should respond to all users who are in the OR, because from now on, the entire surgical team is involved and everyone should be happy with it. By ergonomic analysis, we will take into account: the nature of the surgeries performed, the dimensions of the room, the various fixed and mobile equipment, the layout and size of the displays, the location of the connection points, the atmosphere desired with the possibility of playing music during the operation, the ease of maintaining asepsis, etc. The key is a better quality of work and greater efficiency of the whole team. The patient experience will thus be significantly improved thanks to real teamwork and identification of each person's needs to be carried out upstream of the project.


In conclusion of this first part, to identify your real need, you must:

- Understand what the IT infrastructure of your establishment is based on, its possibilities and its limits, so make a good dimensioning of the network,

- Identify specific needs of the surgical team and translate it into VM features,

- Identify the construction / renovation / redevelopment project as a whole, its challenges and what it implies for your healthcare establishment.

All these actions, if carried out in isolation, might lead you on the wrong track, a solution that will not be adapted and adopted. To avoid this, it is necessaryto enter into a dialogue with all the stakeholders of the project. We explain everything to you in Part II of this article.

Part II : Involve all stakeholders and choose the solution
Click here to access the article.