S U R G I C A L
I M A G I N G
Britain, Conn. "The fiber optics are better made," he notes, recalling experiences with older cables in which the breakage of the fine filaments — 1 or 2 every time the cable was roughly handled during reprocessing — resulted in a gradual degradation of image quality over time. "They've improved the glass strands and packed more of them into the cable for better visualization."
The cameras that capture these sharper images have gotten smaller, too. "We went from 10mm cameras and moderately good pixel strength to HD cameras with many more pixels" that are down to 5mm or less, says Dr. Baxt. "The 3mm cameras get into places that you couldn't get into before."
Miniaturization, says Dr. Gorjala, "adds great improvement to seeing in small areas. Under the liver, doing reflux surgery, or in the chest or pelvis, visualization is phenomenal."
One big advantage of smaller cameras, and consequently smaller incisions, is less intraoperative blood loss and less post-surgical discomfort for patients, says Dr. Barth. But there's also something of a trade-off in shrinking technology. "The bad part of laparoscopy is, you've got a small cone of vision," says Dr. Gorjala. "You can't see the whole area." For example, he says, a surgeon performing an open sigmoid colectomy would easily notice complications involving the appendix. Performing the procedure laparoscopically, however, he wouldn't.
Incomplete visualization can lead to unintended consequences,
