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Laparoscopic Ccd Camera
Fig. 4.1. The new Operating Room suites at Medical College of Virginia incorporate the Endosuite® design for Laparoscopic and Lap-Bariatric procedures.

The 1-CCD cameras use a single charge-coupled device with an overlay of millions of colored filters. Electronics within the camera or camera control unit are able to determine what filter the light hitting a specific point in the CCD is passing through. It is therefore possible to produce a smaller and less expensive camera than a 3-CCD camera; however, resolution and light sensitivity are both compromised.

The trend in surgery has definitely been toward smaller scope diameters, particularly a migration from 10 mm to 5 mm rigid scopes. As a result, utilizing a camera that can perform under the lower light parameters set forth under a 5 mm scope is essential. Moreover, the light source and its intensity must be factored in. When performing a laparoscopic procedure with 5 mm ports, it is often preferred to use a Xenon light source in order to maximize light throughput and guarantee pinnacle resolution.

Voice Activation and Computer Robotics in the Operating Room

There are some inherent shortcomings in the way operating room equipment has been traditionally accessed. The advent of minimally invasive procedures exacerbated these problems and underscored the need to improve upon the surgeon's avenues for integration. Because most of the MIS components reside outside the sterile field, the point person for critical controls became the circulating nurse. This led to increased frustration for the surgeon as well as the nurse. Often times, the

Frustrated Nurses Computers
Fig. 4.2. Three chip digital video camera.

circulator would be out of the room at the precise moment that an adjustment, such as in the level of the insufflator's CO2, had to be made. Surgeons grew frustrated at the subsequent delays, as well as an inability to take their own steps to change things. Additionally, nurses grew weary of such responsibilities. These constant interactions with the video tower pulled nurses away from patient-related tasks and from necessary clerical and operational work. The coup-de-grâce became the nurse's frustration with handling the exponentially higher complexity of video equipment and the invariable troubleshooting that ensued. The answer was certainly pointing toward improving the surgeon's access to these critical devices: voice activation.

Voice activation had been in the works since the late 1960s. Companies such as IBM began to look into developing software programs that would carry out human commands. The Holy Grail was, and continues to be, a simple, safe, and universally acceptable voice recognition system that flawlessly carries out the verbal requests of the user. However, the curve on this development proved steep. The ability to recognize a wide array of speech patterns was a technological hurdle that only today is showing true signs of promise. The good news is that voice recognition is here to stay and has begun to permeate many facets of the life of the everyday consumer. Voice control technology in automobiles, phone systems, and home environmental controls are but a few examples of this.

In 1998 the first FDA approved system for voice activation was introduced into the operating room. That system, known as HERMES, was the result of a co-development project between Stryker Endoscopy and Computer Motion. Designed to provide the surgeon with direct access and control of surgical devices, HERMES is operated via a hand-held pendant and/or surgeon voice commands.

Fig. 4.3. The HERMES™ Command and Control System from Stryker Endoscopy.

The HERMES™ System (Fig. 4.3) gives direct control of surgical devices to the surgeon and provides the OR team with critical information. Surgeons have immediate access to "intelligent" medical devices using simple verbal commands or a hand-held touch-screen pendant. HERMES™ can be used in a broad array of minimally invasive surgical procedures.

To operate the HERMES™ device, the surgeon must take approximately 20 minutes to put his or her voice patterns on a PCMCIA (PC) card. This is accomplished by using a software program that walks the surgeon through a series of commands and captures segments of sounds called phonemes. These sound 'bits' are comprised of the pitch and inflection of how each syllable is formed by the user. When finished, the surgeon places the card inside the HERMES™ controller, which alerts him to the status of the system.

The operation of HERMES™ is relatively easy, with a learning curve of approximately 2-3 cases.

AESOP®

AESOP® (Fig. 4.4) is a voice-activated device, manufactured by Computer Motion, which is designed to hold a laparoscopic camera and scope. The surgeon can use several verbal commands to move the arm (and thus the camera) to keep up with the visual demands of the case. By utilizing a steady robotic arm, the surgeon is not adversely affected by unwanted movements and tremor of the image, often associated with human control of the camera. Moreover, there is less cause to clean the scope when it is controlled in a steadier and more deliberate fashion.

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