The Sterile Eye

A camera solution often suggested to me by surgeons is the headlight camera. Headlights are used by surgeons when the OR’s surgical lights don’t supply enough working light. This is often the case when operating in narrow spaces, e.g. the pelvis minor and the oral cavity.

Mounting a camera on the headlight might sound like a good idea, and some of the headlight manufacturers even supply it as a part of their product line. The Luxtec Corp., for example, has the MicroLux headlight camera, which can be used with their headlight systems. I’ve chosen Luxtec as an example because their own sample videos of the camera reveals the problems of the headlight camera when shooting surgery.

Look! No hands! No heads!
One big advantage of the headlight camera is that you don’t get any surgeons’ heads blocking your view. Because the camera is mounted between the surgeon’s eyes you don’t get many hands in the way either. The camera sees more or less what the surgeon sees.

But there ends the advantages of the system. Even the most focused surgeon does not hold her head locked in position. A headlight can be annoying when shooting surgery, because it is an ever moving light source. The same applies to headlight cameras. The picture is erratic and tiresome to watch. A picture which is always moving and jumping is not pleasant to watch, and consequently unfit to keep the viewers attention.

A good example of this can be seen at the Luxtec Corp.’s own pages. Watch the sample video (eyelid surgery) here.

With longer focal length, camera movement becomes more visible (and annoying), so most of these cameras comes with a fixed, wide angled lens. As you can see in the Luxtec sample video, this results in a good overview of the operating field, but with no possibility to get a closer view of the anatomy and dissection.

“Smallest, lightest”
“Small” and “light” are maybe good advertising words, but when it comes to video cameras they can most often be translated to “single CCD” and “inferior optics”. The MicroLux camera boasts of having both “automatic picture adjustment” and “hands-free auto focus”. To the surgeon this might be helpful features, but in small cameras like this “automatic” means you don’t have the option to adjust exposure and focus manually, which is crucial for consistent quality pictures.

StreamOR
The website StreamOR use a modified “micro-lipstick camera” (which they call “SurgeonCam”) to shoot surgical procedures. It’s basically the same solution as outlined above, but without the headlight. The problems are the same: erratic camera movement and too much distance to the field, as you can see in this video still (which also suffers from hard video compression):

Conclusion
The head- or headlight-mounted camera is not an optimal solution for shooting surgery, and should not be used as the main video source in a production. It can however, sometimes be interesting to include the surgeon’s view of the procedure. Especially in videos used to train other surgeons.

As a medical videographer I’m not comfortable with making the surgeon responsible for the quality of the footage. This system puts the surgeon in control of the camera, but at the same time denies her monitoring of the picture, as the camera always follow her eyes. In my opinion that is not a recipe for quality.

Luxtec are right when they say “Overhead cameras just don’t get the picture”. The only problem is, headlight cameras don’t get it either.

This is the second post in a series about different ways to shoot surgical videos. First post: Surgical light cameras.