The modern surgical operating room has evolved into a significant audio-video system. In addition to robotic surgery and endoscopy, where surgery is performed using a tiny camera inserted into the patient’s body, surgical teams need to share vital imaging systems to safely operate. These imaging devices can be c-arms for live x-rays, ultrasound scanners for soft tissue, and monitoring systems such as haemodynamics, essential for heart surgery.

Episode guest

Colin Dobbyne, Consultant, Big Blue Solutions

Big Blue Solutions was founded by Colin Dobbyne. Colin has designed integrated operating theatres for Smith and Nephew, Conmed and Karl Storz. He is now advising NDS and the 4 Medical IT alliance on how to build the best in class systems that will enable healthcare to break free from closed proprietary systems.

Episode Transcript

Justin Kennington: 00:06

Hello everybody. Hello and welcome to SDVoE LIVE! I’m your host, Justin Kennington, and this is TV for Pro AV. We have a very interesting show for you today. It’s interesting to me personally because although this is a topic in and about Pro AV, it is not a world that I know well at all. So I’m going to learn a lot today and hopefully you will too.

Our guest, Colin Dobbyne, is here to talk with us about SDVoE in the digital operating room. Every time I think about this, I think back to Jerry Seinfeld’s joke, right? Somewhere there’s a patient who’s got something so wrong with him, or doctors want to fix it in such an interesting new way that, they’re going to do it in the operating theater, right? And dozens of other doctors are going to come sit in the theater and watch this happen. And Jerry’s point is you don’t want to be that patient. Don’t be the patient that makes all the other doctors say, “Ooh, I’ve got to see this.” So Colin is here today to talk to us about all of the latest and greatest innovative ways for doctors to have a look at this without having to sit in a hundred seat theater.

We’re going to learn about all the ways that video is a core aspect of what happens in the operating room, why that’s so important, what that enables, and what that means to us and the rest of Pro AV. So, stay tuned because you’re going to hear all that from Colin in just a few minutes.

I want to remind you that today we’ll be having our aftershow with Colin, so if you have something on your mind, something that you want to understand about the digital operating room, write to us live@sdvoe.org, or get us in the chat. If you’re watching us on the SDVoE Academy, or you’re watching us on rAVe’s launch platform, log into that chat right below my feet, interact with your other audience members and get your questions to us there. We have moderators who are watching the chat to get us your questions for the aftershow.

With that, I want to throw it to a quiz so that we can move on with our show.

Oh, Matthew?

Matt Dodd: 02:25

Yeah. Yeah. Tell him I’ll be there in a minute. Oh, Justin, it’s so hot down here in hotline central. The heaters have stuck on. There’s a really balmy lovely day outside and yet I still look as cool as ice, right?

Justin Kennington: 02:41

Spring has truly sprung.

Matt Dodd: 02:44

Yes.

Justin Kennington: 02:44

So how’s it going in the hotline central?

Matt Dodd: 02:46

All good. All good. You can hear it’s busy, busy, busy. Team of moderators, as always, we’re here. Colin’s here with Justin, getting the scrubs on, ready to talk healthcare tech. It’s going to be good this one. Really good. Colin’s a Brit like me of course, so once again, your overruled there, boy. Get your questions and your comments in please, live@sdvoe.org. You don’t need us to tell you this, you know this already. For those of you in academy, use the chat window as well. Get stuck in. We need to hear from you, isn’t that right? We need your feedback. We need feedback on the show as well because it’s important. You need to tell us how we’re doing. Isn’t that right, JK? We need to know how we’re doing. Give us some ideas, some thoughts, and thank you of course all of you for being here again with us.

We’ve had a question already. Shock. Horror. We’ve had a question. Dee Bilson from Lake Jackson asks, is the transition from matrix switches to AV over IP going any differently in the operating room than it is in the rest of Pro AV? That’s a good question.

Justin Kennington: 03:50

I just wrote it down in my notes here. Thank you Dee.

Matt Dodd: 03:52

It’s not a bad question, is it?

Justin Kennington: 03:54

No, not at all.

Matt Dodd: 03:56

Yeah. He’s actually got a computer there. He’s probably just writing anything at the moment.

Justin Kennington: 04:03

Anything.

Matt Dodd: 04:04

Like the man in the orthopedic shoes, I stand corrected. Anyway, is the air conditioning working okay up there?

Justin Kennington: 04:13

Oh, you’re going to love it. You’re going to love it. Come on in. And let’s do the news in here.

Matt Dodd: 04:40

May I? Great.

Oh, oh, that’s so nice. That’s so nice. I know you’re going to send me back down there at some point with all those people and phones and everything buzzing. If somebody can turn the heater off down there, that’d be great. But here we are. Here we are back again in the newsroom.

Justin Kennington: 04:59

Yes, indeed. Yes, indeed. And by the way, Matt, I may be outnumbered. I am not, however, overruled.

Matt Dodd: 05:05

And would we say otherwise? I’ll tell you what, let’s do some news.

One day. EIZO. This company, EIZO, is announcing the 43-inch 4K UHD monitor for endoscopy, it’s EIZO, for endoscopy and the operating room. It’s the most interesting TV advert I’ve ever seen. That’s for sure. 43-inch 4K display that can be reliably attached to the medical cart for endoscopy and for operating room use. Now, I kind of read this thinking, “Yeah, so what?” But then as you read through, you start to understand the really importance of this because normally the screens that they have in there to keep them out the way of these people who, let’s face it, are extremely busy. They’ve got screens on walls and ceilings, great big, heavy screens. They’re further away. Now we’re bringing much higher resolution, much better color depth, even closer to the surgeon so they’re getting a much more real time, large aspect view of what’s going on.

It talks about the Rec 2020 color space that’s used in them. And you can learn more about that in the SDVoE Academy. Don’t forget. There’s a great course on that. Yeah, what did you take from it, JK?

Justin Kennington: 06:25

Well, it’s as simple as that. I just wanted to highlight, for an audience who may not know what role audio and video plays in the operating room, the specs that they highlight on this TV, it’s 4K resolution, it’s HDR support for all of the formats, for BT 2020 color space, for hybrid log gamma luma curves, everything that a modern, very high-end display would have, and then you ask yourself, “Well, why do they need that in the operating room?” As you imagine it out, you realize that many surgeries these days are endoscopic, meaning there’s a camera inside the body. This TV is the surgeon’s eyes. And so this is a world where video quality really and truly matters. And I just thought this particular article about this particular TV really highlighted that point, so I wanted to bring it out. Click on the link below to read more about this set.

Matt Dodd: 07:15

And I like the point at the end it makes about the fact that its equipped with a protective glass to shield it from scratches and dirt and other things you might find in an operating room. Let’s move on shall we?

Justin Kennington: 07:27

Anything that might splash.

Matt Dodd: 07:32

Next piece. This is a really interesting article. Medtronic expands the reach of a AI powered surgical video management and analytics platform. Bit of a mouthful as a piece, but actually read on because it is really interesting. Describes how the work done in the operating room is able to be captured and lifted into the cloud for analysis and training purposes, JK. Very, very interesting use of existing technology and moving it to the cloud.

Justin Kennington: 08:01

And we’ll get in depth on this with Colin, but it’s very valuable to have all of the possible video streams happening in an operating theater, have them recorded for training, as you mentioned, but also imagine for liability, right? Imagine if something goes wrong, having this video as sort of a black box of what happened. But if you have multiple cameras in a room and every time that room is working, all of the video from all of those cameras is being recorded, how do you just deal with the library that you are creating? And again, I use this piece to simply highlight the interesting audio/video challenges that the lay person to the OR, like myself, might not always think about. But this is a system for what to do when you have that pile of video.

So they can use AI to help with privacy, right? You don’t want the patient’s face on the screen. You don’t want any of their personal information. If you’ve ever seen some of your own medical imagery, it probably has your name, your date of birth, printed there alongside the image. Well, this system can recognize that and blur it out. So we can now look at this x-ray for training, but not see this is Matt’s and here’s his birthday and here’s his private credit card numbers and all of that.

It’s also good for the work flow because the AI will be used to segment the video into procedural steps. Let’s not watch all four hours, including the surgeon washing his hands. Who cares? Let’s get to the part where he’s cutting things. And this system will be able to quickly get you there. And for performance of the medical team. This thing can benchmark the performance of each surgery against all of the historical data that it has and says, “Oh, we’re improving. Oh, we’re not improving. Here’s what’s going right. Here’s what’s going wrong.” Again, what’s enlightening for me is to understand the level of AV and in this case, AI technology, that’s being applied to surgery. It’s not a world that I’ve personally worked in before, so I just think it’s interesting to learn.

Matt Dodd: 09:56

Yeah and it’s good to see this cohesion of technology taking place inside the OR, as well as it is everybody else. We’ve seen existing technologies being used, obviously very proprietary endoscopic equipment, and the cohesion with now the technology that we are involved in promoting here, not just in the OR, but also in education and elsewhere, to raise the standards. That growth in standards and quality is always a good thing. You mentioned about if somebody gets it wrong. We’ve got support video to see exactly what went wrong if something went wrong, if somebody’s not doing the job properly. So it’s just that increasing quality and growth in standards. It’s good. I had an operation on my hand once and the guy actually showed, I was allowed to see, it was all anesthetized. And it was the strangest thing. It was like Terminator, very bizarre. Anyway, going from keeping medical records all blurred and keeping them all safe and secure…

Justin Kennington: 10:54

To not.

Matt Dodd: 10:58

This guy. Now, yeah. Why?

Justin Kennington: 11:04

Honestly, this is more… Go click the link below and read it yourself. I mean, it’s funny, it’s amusing. It’s also an example of what not to do, so I suppose it’s not funny in that way.

Matt Dodd: 11:13

Yeah.

Justin Kennington: 11:13

This anesthetist, very passionate about his PlayStation, and not a big fan of the Xbox. No, no, no. He’s a PlayStation guy. He does not like the Xbox guys.

Matt Dodd: 11:24

Of course.

Justin Kennington: 11:24

Yeah. He got into a flame war on Twitter and I guess he probably signaled his credential. “Well, you know I’m a highly paid, well-trained doctor and I’m telling you the PlayStation is better.” Someone didn’t believe him. So of course, what do you do? You post a video of yourself live from an actual surgical procedure with the patient in view, explaining, “See, I am a real doctor.” This of course results in another Twitter flame war, results in your hospital getting a whole flood of one-star reviews on Google. It’s an example of what not to do.

Matt Dodd: 11:56

Go check it out.

Justin Kennington: 11:58

He has since apologized and recognized this is not the right way to behave, but an amusing story about technology in the OR.

Matt Dodd: 12:05

All’s well that ends well. I’m going to leave you with Colin. Have a great interview and I’ll catch you a little bit later on. Bye-bye.

Justin Kennington: 12:11

Thank you, Matt. Our guest, as I’ve mentioned, Colin Dobbyne of Big Blue Solutions. He’s not only a consultant and system architect, but also a futurist and an innovator. Isn’t that right, Colin? Why don’t we bring him on in and let’s talk to him? And a musician, did I mention that? Look at that piano. Hi, Colin. Good to see you.

Colin Dobbyne: 12:32

Good to see you too. How have you been?

Justin Kennington: 12:34

Good. Good. Welcome and thank you for being here. As I’ve said it a lot already this episode, this isn’t my world and I think that’s probably true for a lot of our audience, so why don’t you start out with just kind of an overview. What does the modern operating room look like and what role does AV technology play in it?

Colin Dobbyne: 12:55

Well, I think that there’s lots of sort of drama series now, which actually give you a fairly good idea. I don’t know how popular they are in the US, but certainly here in the UK. You know, there’s one up the road here at Gatwick Hospital where people get a really good view of what goes on inside an operating room. And one of the things that they will undoubtedly see more and more is that there’s just a fantastic use of video, whether it’s for endoscopy, which is used for what we call minimal invasive surgery, or more lay term is keyhole surgery, but there’s all kind of imaging devices out there, so there could be all kind of scanning machines, CARMS, which is like a live x-ray, you’ve got ultrasound. I mean, the list goes on.

And so you’ll see all of these screens and beeps and noises and things, and it’s a mass of electronic devices and that’s really the modern OR. But to some extent, it really depends if you sort of want to say where are we now, which is what I class as surgery 3.0, which is with all of this fantastic Silicon-chip based appliances and devices and cameras, or where we are really rapidly going, which I think is a really exciting journey. It’s been long overdue to be honest and it’s a drum I constantly bang on is getting an OR connected, and this is what we would call surgery 4.0. And that’s really where the whole world of rapid, fast, cloud-based computing and data exchange and things that can really enhance the surgical procedure, and of course, ultimately patient outcomes. But a good way to get a good look at what is a modern OR, just watch one of those drama series.

Justin Kennington: 14:47

That’s funny. I wish I’d thought of that a week ago.

Colin Dobbyne: 14:48

Maybe not Seinfeld.

Justin Kennington: 14:52

Yeah, you’re right, plus that was 30 years ago. So when you bring up the TV example, that’s a great point. I don’t watch medical dramas. They are very popular here. Maybe our audience knows all this because they watch. Shows that I have watched in the past that featured, I mean, I don’t think the medical dramas feature AV, but they show it. I’m thinking of my old favorite show, 24, and you go in the spies’ control room and they’ve got this massive computer network and everybody’s got their own screens and they’re sharing video. And I remember looking at that 20 years ago and thinking like, “This is where we need to get to with AV, the ability to actually do that.” You know, it’s all fake for TV. I’m going somewhere here.

I’m curious, as you watch the modern medical dramas, how realistic is their portrayal of audio/video and how fantastical “we should get there someday” is it?

Colin Dobbyne: 15:43

Yeah. I mean, I suppose when I say watch it, people are kind of absorbed in the problem with the patient and what the surgeon is doing. And actually, nobody really looks too hard at what kind of screen it is or what kind of camera it is. I know many surgeons that couldn’t tell you the manufacturer of the screen they use or even the operating light they use. They just need a good light and they need a good screen. And so it has to be part of the workplace, it’s part of the studio, if you like, that these devices are there, that the image is good. But if you wanted to get a look at it, like I just say, you can see all of the equipment. I mean, there’s a mass of equipment, there’s a mass of cables. And there’s a load of system checks need to be done before with the modern OR.

Justin Kennington: 16:34

Sure.

Colin Dobbyne: Yeah, it is a realistic… I mean, obviously, to be honest with you, it’s like anything when you put it on TV, have a quick tidy up. They’re not always as neat and tidy as the ones you see in the drama. Maybe I shouldn’t say that too much with all my NHS colleagues, but anyway, that’s the reality.

Justin Kennington: Sure, sure. How has AV’s role in this space changed in the last, is it a decade that’s important, is it 15 years, is it five? You mentioned we’re at surgery 3.0 and we’re trying to get to 4.0, what is that transition ultimately about and how are we coming on the path?

Colin Dobbyne: 17:17

Yeah, I mean, AV has been, I would say, a bit more than a decade, but less than 20 years where AV has just rapidly got involved with surgery. And I mean, one of my first customers, he was a pioneer of laparoscopic surgery and he literally had a camera the size of a shoebox, which was an old Videocon tube camera, black and white with massive vignetting, so the image was just a tiny circle in the middle. I mean, I honestly don’t even know how he was able to operate on it. But now, you’ve got these matchbox size CCD camera heads with either 3D or 4K, and it’s amazing, that miniaturization has… We’ve gone through standard definition to HD to now 4K. It’s just always going to be part and an increasingly more so part of surgery. In the end, I suspect that there’ll be very little surgery done without some kind of imaging device.

So it’s very much a part of it and increasingly so. And of course, that then gives you the kind of the headache, which you alluded to in the earlier piece, what are you going to do with all this data? How are you going to manage it all? How are you going to look after it? How are you going to distribute it? How are you going to protect it from security aspects of it? And all those things come into it. And that’s where you need to build a robust ecosystem that you maintain the integrity of the image that you’re looking at, which is essential to good surgery, and also that you’re able to securely manage the data.

Justin Kennington: 19:15

Sure, sure. That makes sense. The answer to this question may seem a little obvious, but I’ll still ask it just to make sure I’ve got a grip. You know, we talked in one of the other earlier news pieces about such a high-end TV being used for the OR. You just mentioned the transition from HD to 4K, even 3D imaging. What’s the purpose? What’s the reason for wanting such demanding imaging specs in the OR? Why do I need such a nice TV there? Why doesn’t my 20-inch HD TV work anymore?

Colin Dobbyne: 19:47

Well, there’s two immediate answers to that. Firstly, the cameras that are being used in surgery are comparable to broadcast cameras. I mean, they are top of the range, high-end, high-specification, high-color depth, 60 frames per second, and to view at its best, of course, you need to have a high-quality screen.

The second point is that with so many imaging modalities within the OR, so not just live cameras, but maybe there’s a radiogram that you want to look at, at the same time, maybe there’s an overview camera or ultrasound or something like that. You know, it’s quite common to put four images on one screen.

Justin Kennington: 20:39

Okay.

Colin Dobbyne: 20:40

Four different images on one screen. And so consequently, you need to have a high-resolution and a large format screen to do that. So that’s why they’re quite popular in the OR.

Justin Kennington: 20:52

Sure. That makes sense. So, I’ve picked up on… I watched one of your presentations that you gave here in the SDVoE Academy. All of you guys click down below to see Colin explain some of this in more detail, but you talked about the transition that’s happening in the OR away from using the matrix switch as your core for video distribution and moving towards AV over IP. What are the benefits to the surgeon, to the operating room environment, of AV over IP instead of just a matrix switch?

Colin Dobbyne: 21:28

Yeah, of course there’s lots of stakeholders involved in an efficient OR, and to be honest, if we are just talking specifically about the surgeon, then the surgeon just wants to see the best possible image that he or she can see with the minimum amount of latency. So, if they’re doing keyhole surgery, for example, if they move their instruments and then it takes some time to pass before they see those instruments move on the screen, that system’s getting unplugged and is going to be thrown away. It’s just unusable like that. So latency is a really important issue. And so they don’t really care, the surgeon, at the time of operating what is bringing that signal to their eyes. It just has to be good enough.

So the advantages though, beyond that primary use case really, is what else can you do with this image? Can you send it down the hall to a seminar room? Can you send it to lecture theater? Can you send it over the LAN]? Can you store it efficiently? You know, does some of that technology help with sort of more kind of electrical safety applications, like I’m thinking, for example, if it’s fiber optic based, it’s naturally what’s we call galvanically isolated, which means that it can’t possibly transfer some residual current or dangerous current to somewhere you don’t want it.

So there’s lots of other things involved in it, but the move really is that I think that people… Even if you don’t know why, I pretty much guess that everybody would say, “Well, eventually everything will be IP, so why don’t we just get on with it and move it across to IP,” and then we’ll figure out the benefits later as we use them and understand them. But, I think that’s really where it’s at. I think the trend was set, but it was clear that the advantages will come.

Justin Kennington: 23:42

Yeah. That makes sense. You also said in the talk that I referenced that you gave a couple of years ago, you said that despite everything that we just talked about, video quality being so important to capture what the camera could see and to be the surgeon’s eyes, that the reason to use SDVoE in particular in the OR is not about video quality. That really stood out to me because that’s one of our key advantages I see, low latency and high image quality. What do you see as the reason that SDVoE is so strong in the operating room?

Colin Dobbyne: 24:17

Yeah. So I mean, it was meant to be a bit of a thought provoking statement and designed to sort of pique a bit of interest. Why should we use SDVoE then? It certainly wasn’t to say that the quality is not good. The fact of the matter is that if you don’t have absolutely high-quality video with no compression artifacts, so lossless video transmission, and zero latency, if you don’t have those two crucial factors, which SDVoE does, then you’re not even in the game. And since there are alternatives, well then clearly they perform similarly, so therefore, the reason to choose SDVoE over another is not at the video quality because that has to be there. So the advantages that I see with SDVoE, and don’t get me wrong, I’ve done some very significant testing on SDVoE to look at are there really artifacts of compression? What is the measured real latency?

I mean, I’ve done my own experiments with that. Actually, I can point you in a direction of that. You can do a really good test with a mobile phone camera actually. But you can do it yourself and you can see that there’s negligible, I mean, you just cannot perceive it. So for all intents and purposes, it’s zero-frame latency. So the advantages are, for me, what else you can do with SDVoE and I think this is where it sits head and shoulders above other video-over-IP solutions, because not only can I include USB extension, I have RS232 control, I have infrared control. Obviously, I’ve got an independent audio. I can spit the audio from the video. I can route it independently from the various encoders and decoders. I’ve got an incredible palette really of audio/video control and data protocols at my disposal to create any kind of a system within an OR.

And I think that’s the reason to use SDVoE. It’s incredibly flexible and there’s always a solution for what you want to do. And the other great thing about it is, you have one commercially kind of available switch to do all of this, to connect all of these bits together. And the cost of a 10 gig port is just, you tell me, I mean, it’s tens of dollars these days, compared to the cost of a 48 port matrix switch. So, that’s another factor. It’s really just a standard 10 gig switch, but the nice thing about SDVoE is that it kind of layers off a one gig network from that. So you have another network in there. So even if what you want to do within the OR has actually got nothing to do with audio and video, its just taking some data from one point and delivering it to another, you could use the one gig network for that and it’s all done. So it’s all done over the same switch in the same network. So I would say-

Justin Kennington: 27:53

Colin, let me pause you right there.

Colin Dobbyne: 27:56

Yeah. Sorry.

Justin Kennington: 27:56

Because I’ve got to get to some other things, but we’re going to pick this up on the after show. You stay right there and you guys stay right there for a fact check.

This is great stuff, Matt.

Matt Dodd: 28:20

Fantastic.

Justin Kennington: 28:21

Tell them quick about our related course.

Matt Dodd: 28:23

Thanks for your question so far. Don’t forget to check out the related course with the resource panel below. There’s loads of really good stuff to look at. There’s even a case study to check out there as well. So we’re going to head straight back to Justin now to find out what’s going on next week and I’ll see you in the aftershow.

Justin Kennington: 28:41

I knew it. I knew as soon as Colin and I got going, we were going to really get going. So stay tuned for the aftershow. There’s going to be a lot to cover. I want to remind you to check out the #SDVoElive, and I need to say thank you to our new sponsor for the show Black Box. So big thanks to Black Box for sponsoring us and you’re going to hear more from them in future episodes. Our next episode, coming up on April the fifth is going to be about SDVoE in eSports. We talked to about that in an episode last season and you guys loved it, so watch for more of that. We will see you again in two weeks. Stay right there for the aftershow. Thanks to Matt for being quick. Thank you to Colin for a great chat. I cannot wait to hear more from you and we’ll see you all in 15 seconds.