No clever title this time. As we have been editing HD projects over the past year we have been collecting sample clips showing surgical and non-surgical training footage. This is just a sample.
The Sony HVR-V1U has proven to be a great camera for use in the sensitive operating room environment. It is lightweight enough to hang over an open incision, the battery life is long and the images are astounding. Given the potential negatives of HDV, we have found it to be a robust format with good color reproduction and ease of editing using Premiere. It is a processor hog and Premiere seems to want to re-index HDV on a regular basis, but the end result is what matters.
As we investigate tapeless ways to capture video including interfacing with new HD medical systems, we are developing some nice material.
But technology aside, as elucidated in this article:
getting great images is as much about knowing what you are looking at as it is knowing how to control your equipment.
For now, enjoy the show. Viewer discretion is advised.
Although lampooned recently on SNL, Macgyver was once a 80's tv show and it is now a noun, verb and adjective. To "Macgyver" something is to improvise, to use Yankee ingenuity to get the job done.
In video production, there is a lot of thinking on one's feet. Sometimes it is simple, sometimes more complex. A bag full of tools and gadgets can make or break a shoot.
Someone started to call the common clothespin a C-47. Apparently Warner Brothers stored clothespins in a bin marked C-47 - or a fancier name was needed to make it sound like something other than a clothespin. Whatever the reason, you can do a lot more than just clip gels and diffusion to a light. You can fasten a piece of cardboard or paper to any number of materials, to create a makeshift teleprompter, flag or bounce card. You can keep cables, headphone wires or other parapharnelia neat. And should you pack too few socks in your carry-on bag, you can do laundry in your hotel sink and hope it dries by morning.
The Ponytail Holder
I sometimes get strange looks when I buy a pack of these at the drug store, but there is nothing cheaper for holding a coil of audio or video cable wrapped tight. Actually you should see the strange look I once got when buying some nylon stockings - I was trying to soften the image of a wrinkly interview subject! You can also use them to secure cables to a tripod leg, utility cart or to keep cables together. The slightly less cheap multi-colored Velcro® strips available at your local home center are good also.
These doohickies, though seldom used unless you are in an office with a drop ceiling, are a great way to secure a light without a stand.
A solid utility cart
For years we used a pair of stainless steel and aluminium carts. These were well balanced and held our 70+ pound OR tripod. This tripod was a beast, originally designed to support a 16mm camera back in the 70's - we used it up until 2003 with our D700, now it is in the basement with the large Anvil cases and the lost ark of the covenant.
Now we use a pair of Rock-n-Roller carts. These things are lightweight and so far indestructible. We got one in 2000 and it still has its original parts, and you can move a VW Bug with it.
Gadgets in the OR
In the OR, when shooting surgery, we use a combination of our own gadgets, plus we get to see the latest gizmos used by surgeons. There are some amazing devices, all of which should make you quite optimistic about surgery.
When opening up an abdomen for surgery, you need to keep the small intestine, omentum or colon out of harm's way. There are some pretty cool choices. The Army-Navy retractor is very useful, compact and has two sized blades for retracting smaller structures. Malleable retractors are basically flat pieces of metal with rounded edges, and are bendable (malleable in medical-ese) so they can be shaped around a particular structure. Self-retaining devices, such as the Wheatlander have the handle like a pair of scissors but the business end looks like two serving forks with the tines bent outward. You squeeze the handle and the tines extend and lock into place, keeping a smaller incision wide open - hands-free (very useful in hernia and axillary surgery). The Thompson retractor, and others like it, use a large ring with ridges, mounted to a vertical support, over the incision. Then several retractor blades are attached to the ring with spring-loaded clips, widening the operative field, also hands-free. From a video point of view, the fewer hands the better!
Most people know the term "cautery" or "cauterize." Cauterization is using heat to seal tissue, as is often done in the eyes or nose. However the electrosurgery device, usually called the Bovie, uses electrical current to cut or coagulate tissue, such as blood vessels or other connective tissues. You can basically cut anything with it. There is a grounding pad placed on the patient's thigh, which takes the excess current and gets rid of it. Another form of energy is ultrasonic energy. A cutting blade vibrates at an extraordinary frequency, cutting or coagulating tissue in the process. Kreskin would be impressed.
Many people who have had surgery are familiar with Skin Staplers, an alternative to skin stitches. In ancient Egypt doctors would use the pincers on an insect to close wounds - for real! However another type of stapler is the surgical stapler. This is hard to explain, but it is a device which uses several rows of staples and a blade to both divide and join structures, depending upon how it is used. These are used to cut bowel and to join segments of bowel together, and for other uses, such as in obesity surgery.
No, this is not the device that turned Bruce Banner into the Hulk. In some types of surgery, notably breast cancer surgery, a radiation-detecting probe is used to find the extent of the spread of cancer. Let me explain. Prior to surgery, the patient is injected with technetium sulfur colloid, a specially designed radioisotope designed to adhere to cancer cells in the lymphatic system. A pre-operative scan shows lymph nodes which have captured the material. Then during surgery, the surgeon moves the probe over the patient's axilla (armpit) and monitors the radiation level detected. A higher number indicates a large take-up of the cancer-adhering material, and that lymph node is removed. They keep at this until the radiation level decreases. The last lymph node detected that is removed indicates the extent of cancer spread, and prevents the need, in some patients, for a complete lymph node dissection at the time of breast cancer lumpectomy. A similar technique uses a blue dye in the same manner. This is about as close to Dr Crusher's medical tricorder as you can get.
Some years ago I helped produce a monthly course on this procedure. We had two OR's wired up with remote control pan-tilt cameras, wireless mics and a video conferencing touch screen control panel, connected by fiber to a conference room in another building. I would sit in the control room, operating the cameras and switching sources (and sometimes recording the non-synchronized switched feed to DVCPRO), while my colleague in the OR would manually move the camera booms, wire up the surgeon for sound, and communicate with me via wireless land-line telephone headsets. We did this two days a month for 6 months in a row at a hospital in Tampa. Fun stuff. Lots of troubleshooting.
Let's say a patient has metastatic cancer. This means cancer originated in another organ, but cancer that spreads tends to go to specific organs, such as the liver. If a patient has tumors inside the liver, detectable using ultrasound, you have limited choices - remove a portion of the liver, or destroy the tumor from the inside. There exists a metal probe, inserted into the tumor guided by ultrasound. Once in place, 5 thin metal tines are extended out to the edges of the tumor. Then an RF signal at a certain frequency is fed into these tines, to destroy the tissue surrounding the tumor, thus cutting it off from its blood supply, and saving the patient from a major operation.
Patients having surgery in the brain or sinuses often have a mass or other offending material that needs to be removed. In the case of a mass inside the brain, you can't go removing large pieces of brain. In the case of the sinus, surgeons use a video endoscope either up the nose or through the room of the mouth along with suction and cutting devices to remove mass quantities of goobers. In either case, how do surgeons know where they are going?
A system of radio frequency receivers is placed near the patient's head, while a transmitter is attached to the tip of the endoscope. By triangulating the position in X-Y-Z space, and synchronizing this 3D position with a 3D reconstruction of the brain or sinus created by a CAT Scan machine, the surgeon gets a real-time 3D roadmap of the surgical field. Motion capture systems work on a similar concept.
Thinking on One's Feet
Troubleshooting your own video system is pretty straightforward. Troubleshooting someone else's system can be a problem. In an OR, the cables are often hidden in conduits, the ceiling or are simply not labeled.
Thinking on your feet can also relate to finding yourself in unexpected circumstances, such as, oh I don't know, being approached by security guards while shooting the exterior of a hospital - hypothetically, or so I have heard :)
Many of the thinking on your feet experiences seem brilliant at the time, but they are not memorable. You do what you gotta do to get the job done.
Truth be told, I used to carry a Swiss Army knife and a roll of duct tape in my leather jacket at all times. Even on airplanes pre-2001. Now most of my multi-tools are property of TSA, but a roll of gaffer's tape still has 1001 uses, but that is a whole blog post of its own.
As always, thanks for reading.