title: Video-microscopy for use in microsurgical aspects of complex hepatobiliary and pancreatic surgery: a preliminary report.
abstract: BACKGROUND
  The use of loupe magnification during complex hepatobiliary and pancreatic (HBP) surgery has become routine. Unfortunately, loupe magnification has several disadvantages including limited magnification, a fixed field and non-variable magnification parameters. The aim of this report is to describe a simple system of video-microscopy for use in open surgery as an alternative to loupe magnification.
  
  
  METHODS
  In video-microscopy, the operative field is displayed on a TV monitor using a high-definition (HD) camera with a special optic mounted on an adjustable mechanical arm. The set-up and application of this system are described and illustrated using examples drawn from pancreaticoduodenectomy, bile duct repair and liver transplantation.
  
  
  RESULTS
  This system is easy to use and can provide variable magnification of ×4-12 at a camera distance of 25-35 cm from the operative field and a depth of field of 15 mm. This system allows the surgeon and assistant to work from a HD TV screen during critical phases of microsurgery.
  
  
  CONCLUSIONS
  The system described here provides better magnification than loupe lenses and thus may be beneficial during complex HPB procedures. Other benefits of this system include the fact that its use decreases neck strain and postural fatigue in the surgeon and it can be used as a tool for documentation and teaching.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. nicholas.nissen@cshs.org
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Nissen
authors.forename: Vijay
authors.initials: V
authors.lastname: Menon
authors.forename: James
authors.initials: J
authors.lastname: Williams
authors.forename: George
authors.initials: G
authors.lastname: Berci
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D007089:Image Enhancement; D016031:Liver Transplantation / Q000295:instrumentation / Q000379:methods*; D018715:Microscopy, Video / Q000295:instrumentation; D008866:Microsurgery / Q000295:instrumentation; D016577:Pancreaticoduodenectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome