Mastering Endoscopic Camera
The assistant handling the camera plays a critical role in ensuring the ergonomics of a surgical procedure by providing a clear and optimal view of the operative field. They should be able to:
- Accurately direct the camera to specific points in the chest cavity.
- Adjust the view by zooming in and out, moving the camera closer or farther as needed.
- Maintain a level horizon at all times for proper orientation.
- Skillfully use the 30° endoscope to facilitate and enhance these tasks.
Endoscopic View
An endoscope connected to a camera head is inserted into the chest to provide an internal view. Since there is no natural light inside the chest cavity, a light source connected to the endoscope via a light cable supplies the necessary illumination.
Significance of effective cable management...
Ergonomically organized cables connecting the camera head to the video system can significantly simplify camera handling, improving efficiency and ease of use during the procedure.
Optimizing Camera Direction
This is accomplished by moving the camera head left, right, up, or down to direct the endoscope toward the target area, ensuring it stays within the inner dotted circle.
Zooming In and Out
Closeup (zoom-in) and overview (zoom-out) are achieved by adjusting the position of the endoscope tip closer to or farther from the target. The degree of zoom depends on the specific surgical task:
- Zoom-in (closeup): Ideal for tasks requiring precision, such as suturing and dissection.
- Zoom-out (overview): Preferred for tasks involving a broader area, such as manipulation.
Zoom-out...
Zoom-out is particularly useful for beginners, as it helps bring the tips of the instruments into view, providing a clearer perspective and facilitating better control during the procedure.
Horizon
Similar to photography, the horizon should always remain level on the video screen during surgery.
- Slight departures (up to 5–10°) are generally acceptable.
- Moderate departures (up to 45°) cause significant ergonomic challenges.
- Drastic departures (over 45°) or an upside-down image make surgery nearly impossible.
The camera head does not perform auto-leveling, so it is the responsibility of the person handling the camera to maintain a horizontal view. Experienced surgeons often align with an imaginary horizon inside the chest to keep the view level. Less experienced individuals can orient the camera head by ensuring its buttons face vertically upward.
30° Endoscope
VATS surgeons predominantly use 30° endoscopes due to their versatility, enabling visualization of areas beyond the direct line of sight. However, this angled view adds complexity to camera handling, requiring precise control and technique.
Rotation
The 30° angle can be rotated in any direction by rotating the endoscope at its connection to the light cable (marked as a 1 on a figure). This rotation enables the surgeon to dynamically adjust the viewing perspective without moving the endoscope tip, enhancing efficiency and precision in the surgical field.
- Upward-pointing light cable results in a downward-directed view.
- Leftward-pointing light cable results in a rightward-directed view, and vice versa.
- Downward-pointing light cable results in an upward-directed view.
Rightward or leftward views are often preferred over downward views because they allow the endoscope to be positioned less horizontally while observing the same target in the chest. This improves ergonomics and reduces pressure on the adjacent ribs.Light Cable...
An upward-pointing light cable should be the default as it provides the most surgeon-friendly view from the above.
Dropping light cable...
The weight of the light cable can cause it to pull downward, leading to an awkward upward-directed view for the surgeon. To avoid this, the camera assistant should consistently monitor and adjust the cable's position.
The limited intercostal space can hinder the endoscope's movement when directed horizontally. This can be tested by positioning the endoscope vertically, where it slides in and out with minimal effort. As the endoscope is directed more horizontally, the required force gradually increases until the endoscope can no longer move in or out of the chest.
side view...
A downward view is ideal for visualizing the center of the chest, while rightward or leftward-directed views are better suited for observing areas on the right and left sides.