A Useful Tool for Intraoperative Photography: Underwater Camera Case

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The use of cameras in the operating room is increasing. However, there is not always a free person or an assistant who is familiar with your camera. In order to take faster and high quality photographs in the operating room, we use under water camera cases. These cases are produced for each type of camera and can be gas sterilized prior to operation.

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... Subsequent studies showed that premade plastic waterproof camera cases could be sterilized by using ethylene oxide gas and then used to cover inexpensive digital cameras for intraoperative photography by physicians. 11,12 This practice has not been reported in veterinary medicine and likely remains underutilized. Training programs have also recognized that video documentation of surgical technique is an essential component for the development of psychomotor skills, adding several new dimensions to the previous use of still images. ...
... Unfortunately, malleable covers are known to affect image quality negatively by distorting the image. Only 1 published study has evaluated the safety of reusing solid waterproof camera cases, 11 although these investigators used a less rigorous model for testing the sterilization process, simply using the cameras in plastic surgery procedures classified as "clean" by the Centers for Disease Control Wound Classification System (http://www.cdc. gov/hicpac/SSI/table7-8-9-10-SSI.html) and culturing the camera cover after each resterilization. ...
Objective: To evaluate the safety and usability of a wearable, waterproof high-definition camera/case for use in surgical image acquisition by sterile personnel. Study Design: An in vitro model was used to study the efficacy of bio-decontamination of camera cases. Usability for intraoperative image acquisition was assessed in clinical procedures. Methods: Two waterproof GoPro Hero4 Silver camera cases were inoculated by immersion in media containing Staph. pseudointermedius or E. coli at ≥ 5.50E+07 colony forming units/mL. Cases were biodecontaminated by manual washing and hydrogen peroxide plasma sterilization. Cultures were obtained by swab and by immersion in enrichment broth, before and after each contamination/decontamination cycles (n=4). The cameras were then applied by a surgeon in clinical procedures using either a headband or handheld mode and were assessed for usability according to 5 user characteristics. Results: Cultures were negative for all post-sterilization swabs. One of 8 cultures was positive in enrichment broth, indicating a low level of contamination in 1 sample. Usability of the camera was considered poor in headband mode, with limited battery life, inability to control camera functions and lack of zoom function affecting usability. Hand held operation of the camera by the primary surgeon improved usability, allowing close-up still and video intraoperative image acquisition. Conclusions: Vaporized hydrogen peroxide sterilization of this camera 23 case is considered effective for biodecontamination, although thorough manual washing is recommended. Hand held operation provided optimal usability for intraoperative photography. Clinical Significance: Sterilization of a waterproof camera may provide a low cost method for intraoperative image documentation.
... To take pictures in a sterile medium, gas sterilised underwater camera cases may be used with almost no added infection risk. [1][2][3] However, we are in the era of smartphones and cameras are used less than they were in the past. We need solutions for smartphones for intraoperative photography. ...
... Of the reconstructive options, microsurgical reconstruction of the breast using deep inferior epigastric artery perforator flap is one of the commonly performed procedures. [1] The donor vessels for the flap are either the internal mammary artery or its perforator and the thoracodorsal vessels. The internal mammary perforator's size is not predictable also access to internal mammary vessels need removal of costal cartilage and is technically difficult. ...
Photographing surgical procedures is sometimes required for documenting techniques and for patient record. It is a powerful tool for teaching, and it can complement drawings and animations. It is important to keep safety aspects present both regarding the patient, the photographer, and the surgeons.
Intraoperative photography is used to obtain images for both education and research purposes, but poses challenges due concerns regarding aseptic technique. Waterproof digital cameras have sterilisable cases that can be used by the surgeon for intraoperative photography. We compared the quality of still intraoperative images obtained by a non-scrubbed observer using a 35 mm single lens reflex (SLR) camera to images obtained by the surgeon using a GoPro camera in a sterilised case. Image quality was scored using a 4 point Likert scale by 3 groups of end users with differing experience: faculty surgeons, surgical residents, and 3rd year veterinary students. Mean ± SEM overall image quality scores were higher for the traditional 35 mm digital SLR camera when compared to the GoPro (3.25 ± 0.08 vs. 2.0 ± 0.08, p < .0001), as were scores for each image characteristic (brightness, colour, sharpness, and contrast). Image quality scores for each camera also differed significantly between user groups, with expert users (faculty and residents) giving lower quality scores when compared to scores from novices (students). Findings suggest that GoPro cameras provide lower intraoperative image quality than digital SLR cameras, although lower quality images may be more accepted by novices than by experienced users.
High-quality medical photography plays an important role in teaching and demonstrating the functional capacity of the hands as well as in medicolegal documentation. Obtaining standardized, high-quality photographs is now an essential component of many surgery practices. The importance of standardized photography in facial and cosmetic surgery has been well documented in previous studies, but no studies have thoroughly addressed the details of photography for hand surgery. In this paper, we provide a set of guidelines and basic camera concepts for different scenarios to help hand surgeons obtain appropriate and informative high-quality photographs. A camera used for medical photography should come equipped with a large sensor size and an optical zoom lens with a focal length ranging anywhere from 14 to 75 mm. In a clinic or office setting, we recommend 6 standardized views of the hand and 4 views for the wrist; additional views should be taken for tendon ruptures, nerve injuries, or other deformities of the hand. For intraoperative pictures, the camera operator should understand the procedure and pertinent anatomy in order to properly obtain high-quality photographs. When digital radiographs are not available and radiographic film must be photographed, it is recommended to reduce the exposure and change the color mode to black and white to obtain the best possible pictures. The goal of medical photography is to present the subject in an accurate and precise fashion.
Advances in digital photography have made it an efficient and economically appealing alternative to conventional photography. Nevertheless, as objective observers and clinical photographers, we must realize that all digital cameras are not created equal. Different digital cameras frequently used in plastic surgery practices (Olympus 600DL, Olympus 2500, Sony DSC-D700, Nikon Coolpix 950, and Nikon D1) were evaluated, using a subject photographed with each camera in the identical lighting conditions, to determine inherent differences in quality, color, and contrast of the resultant photographs. Three different lighting conditions were examined: single soft-box lighting, dual studio flash boxes, and operating room lighting with on-camera flash. The same digital settings (program mode, ISO camera default setting, high quality setting with JPEG compression) were used. Each camera was digitally color balanced using an 18 percent gray card. Raw and color-balanced images were viewed side-by-side. The macro-image capabilities of each camera were also examined. Conventional 35-mm photographs using a 105 macro-lens on Kodachrome and Ektachrome slide film were obtained for comparison. All of the digital cameras performed with noticeable differences, but they maintained consistency in the three different lighting conditions. Digital photographs differed most greatly with respect to quality and contrast, which was especially obvious once color balancing was performed. Marked differences in quality and ability were observed with respect to macro-image capabilities. Inherent differences in features among digital cameras produce dramatically different photographic results with regard to color, contrast, focus, and overall quality. With the increasing use of digital photography in plastic surgery journals and presentations, it must be recognized that digital cameras do not all display photographs of similar quality, especially when used to evaluate skin appearance. To standardize digital photography, the surgeon must realize that switching digital cameras is akin to switching film types. Standardization of digital photographs should include image resolution between 1.5 and 2.7 million pixels, ISO default setting, color balancing with an 18 percent gray card and software, consistency in focal distance, JPEG compression of medium-to-high quality, and backgrounds of medium blue or 18 percent gray.
Standardized, high-quality, preoperative photographs of the nose are critical for preoperative rhinoplasty planning, comparative postoperative assessment, and demonstration of surgical results. To produce these high-quality, reproducible photographs, it is essential to standardize lighting, to properly position the patient in standard views, to avoid lens distortion, and to maintain consistent camera-to-subject distances. Traditional photographic standards have been well documented in the literature; however, most do not address digital photography, and none address digital photography for rhinoplasty. Certain variables in digital photography that are not present in 35-mm photography can be critical to the appearance of the final image. Variables such as image color and contrast (which usually vary between digital cameras), focal length differences between 35-mm and most digital cameras, the effect of resolution and compression on image quality, and the effect of the printing method used can affect the appearance of the external anatomy of the nose in the final print or image. Lack of detail in the external nasal anatomy becomes an issue if the surgeon uses the photograph intraoperatively for reference, as the authors do. Initially, the authors experienced difficulties with observing subtleties in the tip-defining points and tip anatomy using digital photography when compared with our traditional methods of 35-mm photography. The lack of detail in the external anatomy was most prevalent in the frontal and basal views. Thus, the authors have since tailored their photographic methods to document the rhinoplasty patient to maximize the visual information of the external nasal anatomy in the photographic and the printed image. This article is intended to review the photographic principles for standardized rhinoplasty photography, address the additional considerations necessary when using digital photography, discuss the printing variables that can affect overall quality of the printed image, and discuss the authors' new method of photographing the rhinoplasty patient.