Live video manipulator for endoscopy and natural orifice transluminal endoscopic surgery (with videos). 
During fluoroscopy, radiologists and gastroenterologists are able to manipulate live fluoroscopic video for better orientation and visualization.  During endoscopy and natural orifice transluminal endoscopic surgery (NOTES), this function is not currently available.  Particularly during NOTES, the endoscopic image is sometimes inverted, and off-axis operation is required.  Our purpose was to develop and test a prototype live video manipulator (LVM) for endoscopy, laparoscopy, and NOTES.  Prospective ex vivo and in vivo feasibility study.  We developed a prototype LVM software for video image manipulation that can be easily installed on any computer.  The video input is streamed into the computer and can be displayed on a standard monitor.  LVM was tested ex vivo in the following functions: (1) instant live video rotation, (2) vertical or horizontal video inversion, (3) mirror imaging, and (4) digital zooming.  These functions were also tested during upper and lower GI endoscopy, ERCP, diagnostic laparoscopy, and various transvaginal NOTES procedures (cholecystectomy, gastroenterostomy, and sleeve gastrectomy) in porcine models.  Image quality observation between unmanipulated and manipulated live videos.  LVM reliably and easily performed live video manipulation during these tests.  Besides standard definition video signals, LVM is fully compatible with high-definition video endoscopy.  Three observers reported that the subjective image quality was the same in specified areas between manipulated and unmanipulated live videos.  Observation and feasibility study.  LVM reliably and conveniently performed live video manipulations.  LVM requires minimal equipment, capital investment, and maintenance, and is easy to set up.  LVM can be a useful tool in many medical imaging studies, including endoscopy, laparoscopy, and NOTES, either as a built-in technology or as an as-needed add-on feature.