Filming surgery with camcorders

May 15, 2008 § 12 Comments

Medical videographer with a camcorder

The workhorse of most video production – the professional camcorder – is also one of the best tools for shooting a variety of surgical operations. But it has its limitations and for some types of operations it is simply useless.

Next to exposure, access is the biggest problem in filming surgery. All specially designed camera systems, as I’ve written about before, try to overcome the problem of good access to the surgical field. The professional camcorder is however not designed for any specific purpose. It’s designed to be versatile. So access inevitably becomes the biggest challenge when using cameras like this to document surgery. But using the right camera support and choosing the best camera placement, the camcorder can deliver great footage.

Mobility and camera placement
A great advantage of the camcorder is that it’s not fixed to any structures, unlike for example the surgical light camera. It can easily be moved around the OR to find the best possible placement for any part of a procedure.

The number of possible locations for the camera is however restricted by the physical organizing of the OR. In a crowded OR like in the picture below, where are you going to place your camera? For operations on relatively superficial anatomical structures, like for example a thyroidectomy, there’s no problem to get good shots over one of the surgeon’s shoulder:

Laparotomies
For operations on deeper structures (like a laparotomy) however, shooting over the shoulder will not provide the desired access. The other options available is to place the camera at the foot or head end of the operation table. Both of these locations have some problems. At the head end the anesthesiologist and her equipment is usually placed. And a lot of technical equipment, like suction and electrosurgery units are placed at the foot end. This restricts both how close to the table you can put your camera and exactly where you can put it. Normally the head end will be the best choice. Anesthesiologists and -nurses tend to be nice people, and let you stand there.

The angle of the shot is determined by camera placement and distance to the surgical wound. Placing the camera at the foot or head end both results in quite steep angles.

This video still from a retroperitoneal lymph node dissection shows good exposure of the inferior vena cava and abdominal aorta with the camera placed at the head end of the table.

But as you can also gather fom this picture, anatomical structures located higher up in the body, i.e. the kidneys, is impossible to view from this angle. When filming a laparotomy, the angle of the shot is limited both by camera placement and distance to the surgical wound.

Either way the angle of the shot is quite steep. This is not a problem when filming a hysterectomy or bladder resection, but makes it hard to get good shots of for example kidney resections and esophagectomies.

Filming operations that are done through smaller incisions, like for example a lobectomy of the lung is especially challenging with a camcorder. For these operations the camera needs to be placed more directly above the wound.

Camera stand
A standard professional camera tripod will not get the camera high enough relative to the wound. To get good shots it will have to be placed above the surgeons’ heads. To achieve this I use a body-mounted camera rig, as can be seen in the picture at the head of this post. This rig rests on my shoulders and a waist belt, distributing the weight and making it possible to keep the camera from shaking. The camera can be placed above eye height and tilted down. This requires a camera that is not too heavy and has a LCD monitor, as you will not be able to use the viewfinder with this configuration. Using a rig like this makes it easy to constantly adjust the framing to avoid heads and hands in the picture.

I am quite happy with this rig, but a body-mounted solution is of course not ideal for longer operations. But with good planning, I’ve been able to film operations of 10 hours using this rig. Going through the procedure with the surgeons in advance, identifying the interesting parts, you can take frequent breaks and avoid fatigue.

Conclusion
The professional camcorder delivers better video quality than most smaller cameras. It also offers the best control for the cameraman. So for “superficial” surgery, especially in the head and neck area and on the extremities, it is outstanding – the weapon of choice. For operations on deeper structures however, it is not the best camera solution.

This is the fourth post in a series about different ways to shoot surgical videos. First post: Surgical light cameras. Second post: Headlight cameras. Third post: Swan neck camera.

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