Surgical video: how do you film in the operating theatre?

If we had to rank the importance of the stages involved in creating an educational video, video acquisition would surely come top. There’s one main reason for this: it’s very difficult, if not impossible, to make up for the quality of a badly shot video.

If we had to remember just one rule, it would be this : it doesn’t matter how carefully you edit, if the raw material isn’t good quality, the final video won’t be either (and on Youtube or a website, this results in content that isn’t viewed very often).

There are two ways of doing this:

• First-person recording, for example during minimally invasive surgery performed via video capture (microscopies, endoscopies, etc.);
• Third-person recording, particularly during open surgery, using dedicated recording equipment (front camera, sterile stand camera, theatre camera).

This article looks at the subject in detail, giving advice on how to prepare for and carry out filming in the operating theatre calmly and efficiently.

Preparing for the video: crew, equipment, settings

During an entire procedure, the surgeon concentrates exclusively the surgery; it is not possible to ensure the smooth running of the video. This is why it is necessary to assign this role to a third person, who will take care to control the frame throughout the shoot. The ideal person is an operating assistant who knows enough about the surgical steps to intervene and call out the main surgeon (to aime the camera or refocus) without disturbing the procedure, and who can pay particular attention to the surgical highlights.

Technical specifications

The question of technical specifications arises whatever the recording method. Camera settings should always be checked and adjusted (note that the presentation of the settings screen may differ from one model to another):

Résolution: Full HD (or 4K)

Format: MPEG-4

Bitrate: 5 Mbps is enough (for Full-HD)

Choosing the right input resolution not only ensures the quality of the final product, it also helps when it comes to editing: you can’t zoom in or crop a low-quality image, otherwise it will deteriorate the video quality even more.

If possible, reducing the bitrate at the time of shooting will lighten the size of the resulting rush, which is often large, without affecting the fluidity or sharpness of the animation.

Find out more: Understanding the technical characteristics of a video

Filming in the operating theatre: which equipment is best?

For minimally invasive surgery, the question does not arise: the files filmed by the medical device, often the endoscope or microscope, are used.

Once again, in the case of open surgery, the choice of equipment to be used is more complicated. It will depend above all on the needs and constraints at the time of the operation.

The front camera

Fixed to the head of the person operating, it simulates a first-person view. When filming, it is very practical: no need to check that the image is centred or that a head is hiding the area of the operation.

However, there are two things to bear in mind:

• The image moves with the operator’s head. To obtain a stable image, head movements must therefore be kept to a minimum, which can restrict operating movements.
• The camera is wide-angle. In other words, it captures a very wide image and makes the subjects smaller. In the case of surgery, this poses a problem because the small areas of interest end up in the frame.

The camera on a stand, or exoscope

An exoscope is a sterile camera on a stand, specially designed for filming in hospitals or clinics, and installed in the operating field on an articulated arm.

In terms of video acquisition, it is best suited to the challenges of surgical video: it generates high-quality videos and benefits from a powerful zoom, two important criteria.

However, it is more restrictive. Filming must be anticipated, as it needs to be sterilised or protected by a sterile drape and then installed before the start of the operation. In addition, the control screen must be checked regularly to avoid errors (obstacles, poor focus, etc.).

The room camera

Room cameras are often installed on the ceiling of the operating theatre. They are easier to use as they do not need to be installed. What’s more, they can be switched on at any time during the operation.

However, while they are practical for unplanned recordings, they have two major disadvantages:

• They are generally fixed high up against the ceiling, and obstructions (heads, hands) are difficult to avoid;
• The quality of the rushes is often poorer than that of other devices.