Karl Storz- Endoscopy market leader with a distinguished past and a bright future
by Clive Aylward-Marchant
Established by Dr Karl Storz in 1945, Karl Storz celebrated its 60th anniversary in 2005. During over 60 years of resounding market presence, the company has evolved into a manufacturer known and appreciated worldwide for its quality and product innovations, says the spokesman.
From its headquarters in Tuttlingen (Germany), Karl Storz has developed from a two-men business into a globally operating company. Today it employs 4.000 people worldwide, with 1,800 people alone working at the company’s headquarters and production facility in Tuttlingen. Seven other production sites (in Europe and the USA) and 35 sales and marketing subsidiaries are located worldwide in 32 countries.
Among these subsidiaries is the Karl Storz Regional Centre for Endoscopy (RCE) in Beirut, Lebanon which was established in 2000. “The main aim of the regional office is to understand the particular needs of the people and providing them with Karl Storz products and technical support as well as increased educational and scientific activities (courses, workshops and hands-on training),” says a spokesman. The corporate history of the family-owned Karl Storz is an impressive example of how the company has succeeded over six decades to understand and identify the needs and requirements of customers and market trends and to implement these in terms of products and services by achieving technology leadership and by offering a comprehensive and adaptable range of endoscopic systems.
A history of surgical innovation
Taking a retrospective look at endoscopy, the method initially evolved from the fields of bronchoscopy, urology and gynaecology, eventually encompassing other specialties, in particular laparoscopy. Over the decades, endoscopy has been increasingly used therapeutically. The term “minimally invasive surgery” was coined at the end of the eighties. At that time the broad acceptance of this method has begun so that it is now widely used for many applications in various medical disciplines.
The early and promising focus on endoscopy by Karl Storz began at a time when endoscopy was still at a very early stage of development. As early as 1953, Dr Karl Storz designed and built his first endoscope, at that time still with the conventional optical system, and thus marked the beginning of endoscopy in his small business. Working closely in intensive dialogue with leading physicians, the following decades saw the company inventing and developing devices and systems which decisively shaped and allowed the use of endoscopy in diagnosis and therapy to the extent we know today. The early and pioneering inventions by Dr Karl Storz – for instance, the extracorporeal electronic flash in 1956 and the cold light source in 1960 – set new and long-term standards for enhanced illumination and the resulting options of improved documentation. The year 1965 was the first year Dr Karl Storz collaborated with the physicist Prof Dr Harold H. Hopkins. With the launch of the patented Hopkins rod-lens system, Karl Storz was able to offer endoscopes in superior image quality and with brilliance, depth of focus, excellent resolution and true colour rendition.
As early as 1966 Karl Storz became active in the field of urology. In 1970, the company presented its ultrasound lithotripter, which allowed efficient and gentle stone fragmentation in the urinary system. In 1982, the automatically controlled high frequency electrosurgical unit Autocon marked a breakthrough in transurethral resection, lowering the patient’s current exposure by about 50 per cent. What began in the fifties and sixties as new techniques for improving illumination and documentation as well as creating previously unseen image quality, was pursued consistently in the 21st century. Karl Storz also works closely with many endoscopic training centres around the world. The company supports the training efforts of this medical institutions in providing state-of-the-art products in order to offer optimal training conditions so that surgeons could be trained in, and get familiar with, the specifics of endoscopic applications.
A spokesman says, “Looking at the future of endoscopy shows that the potential of Karl Storz research and development lies in the fact that the company is capable of identifying trends at a very early stage and implements these with its own intelligent approaches and solutions into successful products and systems. Karl Storz accepts the crucial challenge of always keeping a finger on the pulse of current medical developments. The company continually provides fresh impetus, allowing technical innovations to be used for endoscopy or expanding the use of endoscopy into new and innovative fields.”
An integrated approach to research and development
The Karl Storz business strategy is based on long-term and sustainable planning and the maintenance of consistent high quality. To ensure optimal use of resources in the Karl Storz group, research is conducted at each production site. This enables the company to continuously provide physicians with product solutions in the following medical disciplines: neuro-endoscopy, oral and maxillofacial surgery, ear, nose and throat, plastic surgery, anaesthesia and emergency medicine, cardiovascular surgery, thoracic surgery, gastroenterology, laparoscopy, gynaecology, urology, proctology, arthroscopy and sports medicine, spine surgery, paediatrics, telepresence, and OR1 – the integrated operating room (OR). “The company owes its leading market position to high quality products and that each further development has been designed with a modular system in mind that accommodates the physician’s needs,” says a spokesman. “Forward and backward compatibility as well as the possibility to integrate existing instrument sets into new systems is always taken into account when planning new developments. This is a significant criterion for many buyers on a limited budget.”
The operating room of the future
This principle has guided Karl Storz’s developments over the years, culminating in the development of OR1 – the integrated operating room of the future, a particular emphasis is still placed on the continuous development of the complete solution OR solution. The OR1 is a unique concept which allows the integration of numerous technologies in the operating room. At the heart of the OR1 concept is the direct central control of all surgical and peripheral devices via touch screen or speech control from within the sterile area. In this way, operating procedures are accelerated both before, during and after the intervention, and the risk of incorrect operation is reduced. An integrated digital recording system makes it easier to archive image, video and audio data from important operative procedures and results, both for patient documentation and scientific evaluations.
At the heart of the OR1 concept is the Storz Communication Bus (SCB), the centralised control of all operating room equipment and peripheral instruments via touch screen or voice control directly from the sterile area. This helps to speed up work processes before, during, and after surgical interventions and reduces the risk of potential user errors. An integrated digital recording system – Karl Storz AIDA – allows the archiving of image, video and audio data of important steps and results of the intervention for both patient and scientific documentation. Its integration into HIS (Hospital Information System) and PACS (Picture Archiving & Communication System) ensures rapid access to patient and image data. By integrating the latest audio and video technology, telemedicine applications such as video conferences or live operations for teaching and training purposes can easily and conveniently be controlled and operated directly from the operating field. With the virtual presence of an expert consultant, second opinions can be easily obtained. The modular structure of the system allows the step-by-step integration of centralised control, image capture and archiving as well as telemedicine into the existing operating room.
A spokesman explains, “Like a perfect dice, there are six sides to the OR and each side represents a performance module: The OR1TM room stands for centralized control; the OR software module ORchestrion for optimized work processes; and HD technology for revolutionary viewing quality. Another side signifies our instrument service ENDOPROTECT1TM; and yet another professional partner: MedPlan, a bespoke contractor for hospital and OR planning that designs, develops and delivers turnkey medical facilities. The last side is reserved for Karl Storz Solutions, who support you in every project phase from the first consultation through to financing. No matter how you roll the dice, OR1TM performance modules always provide the winning combination.”
In 2008 Karl Storz and Livedata, the leader in real-time data integration and display technology, announced an exclusive distribution agreement to Combine OR1 and OR-Dashboard Technologies. Under terms of the agreement, Karl Storz will add LiveData’s latest data integration and display capabilities to the OR1 system. Combining these technologies brings hospitals a true Patient-Aware Operating Room, where the surgical team can focus more fully and effectively on the patient.
“Combining the strengths of our OR1 technologies with the innovative data integration and display capabilities of OR-Dashboard helps give surgical teams a complete picture of what is going on in the operating room right as it is happening,” said Connie Padden, Director of Technology Integration at Karl Storz. “Additionally, hospitals gain a greater ability to optimize OR activities by streamlining and strengthening resource management. Most importantly, enhanced OR communication and smoother-running procedures mean enhanced levels of care for patients.”
New Image Hub harnesses HD technology
One of the most recent inventions is the Karl Storz Full HD Platform IMAGE1 HUBTM. In the economy, innovation is required to ensure a viable future. High definition (HD) technology, known as HDTV in consumer products, promises substantial improvements in the quality of endoscopic video documentation. Therefore Karl Storz designed the existing video platform IMAGE1TM with an “open architecture for new video technologies” as early as the time of its market launch in 2001, and had the vision to make it “HD-ready”, which now permits every user to make a minor upgrade to take maximum advantage of HD technology.
The new HD platform IMAGE1 HUBTM HD affords the user highest image quality for the precise display of even the finest tissue and vessel structures with the maximum physical image resolution specified for HD at 1920 x 1080p pixels, which constitutes a 5-fold increase in image information compared with the current PAL standard.
The 16:10 wide screen display improves orientation, affording early instrument detection and optimized instrument guidance, especially in the difficult lateral area. The upper and lower image edges are not cropped in the process, permitting consistent control and view of the needle, even in difficult ligatures.
The faster reaction time of the new LCD elements featured by the full-HD monitor generation ensures a smooth image sequence even with very rapid camera movements; this is made possible by the 1080p progressive scan permits flat screen monitors to display 50 full images per second directly and without delaying deinterlacing (conversion from interlaced to progressive scan via an algorithm), resulting in a faster and sharper display. The image generation time is nearly cut in half, resulting in a consistently smooth and sharp image.
In addition to the above-mentioned delay-free display, the 1080p technology (p for progressive scan) employed by the IMAGE1TM hub platform affords every user of Karl Storz IMAGE1 HUBTM HD cameras twice the image information in the 50 Hertz mode, when compared with systemy working in the 1080i mode (i for interlaced scan).
Consistent superior viewing conditions are a prerequisite for the optimal course of any surgery. They are guaranteed by the IMAGE1 HUBTM HD video system and by the largest LCD monitors approved for medical applications worldwide, ranging from 23 inch to 55 inches in diagonal size.
The later integration of future technologies is made possible by the one-of-its-kind open architecture of modular slide-in technology in the IMAGE1 HUBTM HD system. The ability to simply upgrade and expand the system in the future essentially means significant future savings, compared to purchasing new equipment all over again. The IMAGE1 HUBTM HD offers a cross-specialty multidisciplinary application. Its compatibility with existing IMAGE1TM camera heads and the world renowned HD compatible HOPKINS® II telescopes also contribute to this characteristic.
The picture-in-picture display integrated into the HD monitors and the capability to control cold light sources and soon also insufflators via the programmable camera head keys facilitate its multidisciplinary use, as does the integrated digital Moiré filter for straightforward fiberscope use and video endoscope compatibility such as the compatibility with the latest product with distal-chip-technology – the TIPCAM1TM.
Since the IMAGE1 HUBTM HD system, even in the standard version, is ready to be integrated into the OR1TM via SCB (Storz Communication Bus), the path is clear for the expansion into the OR of the future, the OR1TM HD.