Comparison between camcorder, frontal head and temporal mounted action-cam in digestive surgery: Documentation and educational alternative during COVID-19 pandemic

Objective COVID-19 pandemic has made impact both in clinical and educational settings. The number of surgeries has decreased; thus, the surgery videos of all cases are important for both documentation and education. This study aimed to compare three kinds of cameras in recording digestive surgery. Methods We compared three cameras: Panasonic HV-770 Full HD Camcorder, Sony FDR-X3000 Action-cam, and Ordro EP7 Hands-Free FPV Camera. Each camera was used in several recording for superficial and visceral digestive surgeries and we compared the following: operation field, image focus, surgeon's comfort, practicality, and record settings. Results Camcorder needs 10–15 min to set up and longer dismounting time, has steady vantage view and focus, good image quality, can be zoomed, but the recording may be obstructed by the surgeon's head. Action camera needs 5–10 min to set up and the dismounting time was equal between Camcorder and Ordro. Action camera depicts surgeon's vision, however, zoom could not be applied while recording. Sony FDR-X3000 used in this study had good image quality, but the use of this camera in a long surgery may generate neck stiffness due to its weight. Ordro EP7 was comfortable in any surgery but it had inferior image quality compared to the others. Conclusions Panasonic HC-V770 and Sony FDR X3000 had good image quality, where camcorder excelled in longer surgeries due to its comfort, action-cam excelled for shorter surgeries due to ease of use and settings. Ordro EP7 was the most comfortable among all but has lowest image quality.


Introduction
Surgical recording is widely increasing in this era. Recording surgical procedures has numerous advantages. In clinical settings, surgery recording may give the ability to review the surgery process and results, aid in future management planning and referral, act as objective evidence if needed, serve audit purposes, and aid in the implementation of good medical practice. For surgeons, the ability to record procedures from their point of view offers opportunities to analyze surgical performance and provide objective feedback for appraisal and assessment [1]. In education settings, surgical procedure recording can help students to understand text-based materials and actual three-dimensional surgical field of view, demonstrating surgical procedures, assessing surgeons' and students' skills to improve service quality, providing unique opportunity to see rare surgical cases, and act as research tools and visual supplements to medical journals. For patients, surgical videos may help the understanding of their body and condition [1][2][3][4][5][6][7].
The Coronavirus Disease 2019 (COVID-19) pandemic settings since 2020 have required health protocol, physical distancing, and even total lock down period all over the world and in all sectors, including education, and as a result, surgical recording can aid in shifting from conventional learning process to online teaching [5,8].
In surgical recordings, the camera type is a major factor to consider. Recording cameras are widely available in the market, and the one most used in surgery is the camera built into a head lamp. This camera has good video quality but is not suitable for all head lamp types, expensive, difficult to install, limiting surgeons' movement, and needing monitoring in recording. The use of other types of cameras such as action camera with or without modifications have been reported recently. Many surgeons choose Full High Definition (FHD) cameras with wireless remote to monitor vantage points. In this study, we compared three cameras: one camcorder and two action-cam, with three different record position that are widely used in surgical recording to determine the best camera types and ways for surgery recording in various settings.

Materials and methods
The inclusion criteria of this study were: the patients agreed by signed informed consent to undergo digestive surgery recording in elective surgery cases, and the patients were confirmed COVID-19 free from screening and examinations. We exclude patients with emergency surgical cases. All equipment used in this study were disinfected with 70% alcohol prior to entering the operating room.
This study compared three types of cameras by assessing the camera settings before the operation and after surgery. Table 1 shows the three cameras' specifications. Physical comparison of the cameras can be seen in Figs. 1-3 (see Table 2). For the Panasonic HC-V770, we used an inverted L-shaped stand with the tip fixed on the operating table and the other end mounted with a flexible arm and camera mounting. We connected it with a power bank with an extended cable to anticipate if the surgery took more than 2 h. Our Sony FDR-X3000 and Ordro EP7 action camera were mounted on the operator's head and connected to the power bank for medium and long surgery. We modified the head mounting for Sony FDR-X3000 by adding a clip to the inner shell of the construction helmet that was integrated with the head mounting to give more stability to the cameras. Ordro EP7 action camera was ready to use with a headband that was provided in the retail package.
We recorded 30 surgeries, from 10 patients for each camera in total for 5 superficial and 5 visceral surgery procedures. The Institutional Review Board of Faculty of Medicine, Public Health and Nursing approved this study (KE/FK/0796/EC/2018).

Results
All patients who agreed to have their surgery recorded on our computer system were offered the opportunity to see highlights of their surgery recorded simultaneously on the digital video recorder. The comparison of the three cameras is shown in the following table. Sample images of all cameras during superficial organ surgery can be seen in Figs. 4a, 5a and 6a. While the pictures during performing deep organ, surgery are seen in Figs. 4b, 5b and 6b.

Discussion
This study compared three types of cameras, namely Panasonic HC-V770 Full-HD Camcorder, Sony FDR X3000 Action Camera, and Ordro EP7 Hands-free Head-wearing Mini DV Camera. The most popular cameras in this market are GoPro Action Cameras (several models), Contour HD Helmet Camera, Panasonic HX-A100 POV Camcorder, and   Google Glass. The ideal camera to record surgeries should be small, lightweight, comfortable, user friendly, able to depict surgeon's view, provide high definition images and videos, has long battery life, affordable, and enable an easy image or video management. To this date, this ideal kind of camera does not exist.
In this study, Panasonic HC-V770 Full-HD Camcorder needed 10-15 min for setting, Sony FDR X3000 took 5-10 min, and Ordro EP7 took less than 5 min. The Panasonic camcorder takes time for setting and dismounting, which made it more suitable for long surgeries, for example laparotomy, which do not need organ details and the procedures are done in superficial organ because it stands on external mounting. The camera being mounted on an external stand made it the most comfortable for the surgeon, providing steady vantage point and focus, with good image quality, that could be zoomed while recording, but may be obstructed by the surgeon's head at times.
Both action cameras need shorter time to set and dismount, able to depict surgeon's view, and could be controlled while recording using iOS or Android based Smartphone application. However, neither could be zoomed, and both had limited battery life (which could be solved by connecting common external power battery similar to phone's). Also, if   initial camera direction setting was off, the entire recording would fail to point in the correct direction.
Sony FDR X3000 Action Camera has a high resolution sensor to give the best image quality among the three, even when the image was zoomed in the editing process, the fast autofocus, and the ability to be mounted of forehead with head band made it suitable for short to medium surgeries which require details, such as bile duct attachment and procedures on retroperitoneal or pelvic organs. However, its weight made it not suitable for long surgeries because neck stiffness occurred.
Ordro EP7 is a versatile head mounted action camera, lightweight and convenient to use and set. It is comfortable for any kinds of surgery, but the image quality was poor for visceral structures, even for superficial structures, hence zooming the image during editing was unfeasible, and the autofocus was slow. Setting the image quality to the best option may aid to slightly improve the output.
Previous study using head mounted Sony FDR-X3000R for liver transplant recording, very helpful for education supplementation due to high image quality and easy to edit. The most popular camera to record surgery procedures today is the GoPro Hero 6, due to high availability in the market and it is easy to use but has limited image quality [4,12]. Another study modified their own camera, that met the criteria for perfect surgical recording: narrow vantage point, HD image, detailed to small structure, head mounted, controlled from distance, can zoom, no need post record editing and the video can be used directly after recording, but it is expensive, heavy, less comfortable and not practical [13]. Technology's role in surgery is expected to continue to increase, with a projected $5.1 billion market for head mounted displays (HMDs) in the health care industry within the next decade [14]. In the end, whether cameras are good depends on what procedures we want to record, for example, the use of a combination of top mounted camcorder such as the Panasonic HC-V770 for fixed wide vantage point and head mounted action-cam for moving vantage points can be considered.
This study had limitations as we only used one particular camera for each camera type which does not rule the possibility of different result between cameras in the same type, we didn't use standardized surgical camera instead we use action camera although we need make a custom mounting for the camera and the comparation was made by one surgeon which does not rule the possibility of different experience between surgeons. Further study with larger sample size, more camera types, and more evaluator needed to determine the best camera for surgery recording.

Conclusions
The most important point of surgery recording is image quality. Panasonic HC-V770 Full-HD Camcorder and Sony FDR X3000 Action Camera have good image quality, and the Camcorder excelled in longer surgeries due to its comfort, whereas the Action Camera excelled in shorter surgeries due to its ease of use and settings. Ordro EP7 was the most comfortable among all but due to its lower image quality, it became the least favourite camera for surgery recordings.

Declaration of competing interest
The authors declare that they have no competing interests.