Intraoperative Video Production With a Head-Mounted Consumer Video Camera

Abstract

Summary: 

The use of high-definition video in surgical education is becoming increasingly popular. Because of the availability of relatively inexpensive, consumer-grade video cameras, surgeons with minimal video production experience can produce high-quality surgical videos. A number of video capture methods are available, with varying degrees of production quality, economic constraint, and level of attention required from the operating surgeon. The accompanying video provides an overview of the advantages and disadvantages of several options and describes a technique for capturing intraoperative video with the use of a head-mounted, consumer video camera.

BACKGROUND

The use of high-definition video in surgical education is becoming increasingly popular. Orthopaedic surgeons, trainees, and patients can view thousands of free and paid-access surgical technique videos on the Internet. The American Academy of Orthopaedic Surgery and Orthopaedic Trauma Association have recognized the unique educational value associated with this content and have integrated surgical video theaters into their annual educational meetings.^1,2

Because of the widespread availability of relatively inexpensive, consumer-grade video cameras, surgeons with minimal video production experience can produce high-quality surgical videos. However, the learning curve is steep, with few resources to guide the collection or editing of this content. Bright surgical field lighting, against the dim background of the operative suite, makes obtaining properly exposed video challenging. Adjusting field of view or image resolution may improve image detail, but may come at the expense of inappropriate image exposure or distortion due to the camera's wide-angle lens. As a result of these variables, many surgical videos are of poor quality, encumbered by excessive camera movement, an uncentered or overexposed surgical site, or lack of sufficient anatomic detail.

A number of intraoperative video capture methods are available. Surgeons may choose to hire a videographer, capture footage from a tripod or ceiling-mounted camera, or use a head-mounted device. Each of these options provides varying degrees of production quality, economic constraint, and attention required from the operating surgeon.

Head-mounted, consumer video cameras provide an ideal combination of video quality and portability, at the lowest cost. One such device is the GoPro Hero 4 action camera (San Mateo, CA). Its small size, light weight, ultra-high definition recording capabilities, exposure options, and wireless video transmission capabilities make it an excellent choice for collecting intraoperative content. The accompanying video provides an overview of the advantages and disadvantages of several options for producing intraoperative content and describes a technique for the use of a head-mounted, GoPro Hero 4 camera (see Video, Supplemental Digital Content 1, https://links.lww.com/JOT/A36).

VIDEO/TECHNIQUE

Before the surgical procedure, the GoPro Hero 4 camera is mounted to a surgical headlamp. If the procedure is expected to take in excess of 1 hour, an external battery pack is used to extend the camera's operating time to approximately 10 hours. The battery pack fits in the surgeon's scrub pant pocket and is connected to the camera through a USB cable. A 128 GB (gigabyte) microSD card enables up to 9 hours of 1080p (1920 by 1080 pixels), 30 frames-per-second, high-definition video recording.

Both light metering and surgical subject centering pose unique challenges when filming from a head-mounted device. The use of spot metering rather than autoexposure increases the likelihood of appropriate surgical subject exposure, provided the surgical subject is well centered. The use of the GoPro App (application) during the procedure enables the surgeon to monitor a live view of the video recording, confirming appropriate surgical subject centering and exposure. Many phone or tablet devices can be used to run this application. The device may be placed in a clear, sterile bag and secured to the operative field, allowing the surgeon to both monitor subject centering and exposure as well as control the camera wirelessly during the procedure.

Lens modifications allow the surgeon to swap the original, 2.92 mm, wide field of view, “fish-eye” lens with a narrow field of view lens more appropriate for intraoperative use. These lenses minimize wide-angle distortion and maximize anatomic detail, drastically improving intraoperative video quality. Use of a 3.97-mm or 4.35-mm lens provides ideal footage of intramedullary nailing or closed reduction techniques, when a view of the entire extremity is desired. Use of a 5.4-mm or 7.2-mm lens more appropriately records the fine anatomic detail of a surgical dissection and open fracture reduction. Finally, using motion stabilization software during video editing artificially stabilizes inadvertent head movement, improving video esthetics.

Intraoperative video remains a valuable educational tool, second only to direct observation of a surgical procedure. As technology improves, digital video cameras will continue to shrink in size, cost, and produce higher-quality content, enabling surgeons to single-handedly produce intraoperative videos of extraordinary educational value. Propagation of this media through surgical video theaters or Internet repositories will undoubtedly enhance the training of surgeons around the world and remain a prominent feature of orthopaedic education.