November 17, 2000

A Yale physician has conducted what is believed to be the first endoscopic surgical procedures using high definition television (HDTV), which more than doubles the sharpness of the image when compared to current technology.

Steven Palter, M.D., assistant professor of obstetrics and gynecology at Yale School of Medicine, said in a presentation this week at the Global Congress of Gynecologic Endoscopy in Orlando, Fla., that he has performed five endoscopic procedures with HDTV.

An endoscope is an instrument that visually examines the interior of a bodily canal or hollow organ such as the colon, bladder or stomach. A camera on the endoscope sends the image to a processing unit. The unit then relays the picture to a recorder, which projects the image onto a screen or monitor to guide the physician.

HDTV is popular because its three dimensional effect increases the sense of realism for the viewer. Until now, HDTV cameras have been prohibitively large and expensive, making them unusable for surgical endoscopy. A specially designed miniaturized HDTV camera system, along with high definition upgrades in the accompanying processing and projection systems, were used in these procedures. Four of the procedures were laparoscopies, which involve making a tiny incision in the abdomen and inserting an endoscope to view the internal organs. This procedure is often used in tubal ligations and gall bladder removals. The fifth procedure was a hysteroscopy, in which the endoscope is inserted through the vagina into the uterus.

“As far as we know, this technology has never been used this way,” said Palter, who spoke at a special plenary session about how digital technology will change medicine in the future. “We did a series of cases using the equipment, and they were all successful. The system provided the best image we have ever seen.”

In addition to HDTV, topics at the special session included virtual reality simulators and Internet streaming video. Special HDTV projectors were used to project images from Palter’s surgeries for the audience to see.

“High definition television provides more than double the previous resolution, from less than 500 lines to more than 1,000 lines,” Palter said. “It’s like looking through a window. It’s that clear.”

More and more surgical procedures are being conducted through endoscopy because it results in a more rapid recovery for the patient. The incisions are smaller, and, as a result, the costs are lower because it eliminates or minimizes the need for hospitalization.

“When you use HDTV in surgery, you can see tiny details and structures that were not visible before,” Palter said. “We believe that this will translate into increased accuracy, decreased errors and decreased surgeon fatigue, which are the advantages of the HDTV system.”