A new video recording setup in oculoplastic surgery using a magnetic neck mount and iPhone

Abstract

To describe a novel, low-cost, and high-quality intraoperative video recording setup for oculoplastic surgery using a magnetic neck-mounted smartphone holder and iPhone with the Final Cut Camera app. A magnetic neck mount (Tianzhu Insta 360, China) and an iPhone 16 Pro Max were adapted for surgical recording by securing the holder around the binocular base of the operating microscope. The magnetically attached phone provided a stable and adjustable platform, allowing intraoperative view adjustments via the microscope’s handles or foot pedal without compromising sterility. The Final Cut Camera app enabled 4K video capture with manual control of focus, exposure, and white balance. Its Live Multicam feature allowed simultaneous multi-angle recording and real-time monitoring via a compatible iPad, enabling an assistant to control framing and clarity intraoperatively. A multi-port adapter was used to support continuous power and external memory. Over six months, more than 50 oculoplastic procedures, including dacryocystorhinostomy, orbitotomy, and eyelid surgeries, were successfully recorded using this setup. All recordings were stable, centered, and of high image quality. Screenshots captured during surgery clearly depicted anatomical structures under standard operating room lighting. This smartphone-based recording method offers a simple, cost-effective, and ergonomically practical alternative to traditional surgical video systems in oculoplastic procedures. Its adaptability, ease of use, and compatibility with sterile environments make it an ideal solution for surgical documentation and teaching, especially in resource-limited settings.

Recording anterior segment and vitreoretinal surgeries is relatively straightforward as modern operating microscopes often include integrated video capture systems. Oculoplastic procedures are generally performed without an operating microscope as they often involve larger surgical fields that are not well suited to the microscope’s narrow field of view. As a result, these surgeries are commonly recorded using head-mounted cameras or external devices. Head-mounted camera systems can be expensive and uncomfortable during prolonged procedures and often produce suboptimal footage because of motion-induced blurring. For delicate, small-field procedures—such as punctal or canalicular surgery—an operating microscope remains appropriate to provide the necessary magnification and precision.[1]

Smartphones mounted on stands or tripods have gained popularity as an affordable alternative for oculoplastic surgery imaging. However, these setups are limited by their inability to remain close to the surgical field and the difficulty of making intraoperative adjustments in positioning or image clarity while maintaining sterility.

A magnetic neck mount for smartphones has recently become a popular hands-free filming tool on social media. In this report, we present a low-cost, simple, adjustable, and high-quality surgical video recording setup using this tool in oculoplastic surgery.

Technique

A magnetic neck mount smartphone holder (Tianzhu Insta 360, China) priced at approximately $20 was used with a smartphone (iPhone 16 Pro Max, Apple Inc., Cupertino, CA, USA) for intraoperative video recording [Fig. 1a]. The flexible arm of the holder was securely wrapped around the operating microscope’s binocular head (Leica M844 F40, Germany). It should be noted that the operating microscope was not used for surgical visualization or illumination. Instead, two overhead surgical lights were used to provide consistent and adequate illumination of the field. When positioned at appropriate angles, these lights effectively prevent shadowing or obstruction from the microscope or the mounted recording system [Fig. 1b]. The phone was then attached to the magnetic part of the holder [Video 1]. This configuration allowed easy repositioning of the camera to maintain a centered surgical view and enabled intraoperative adjustments by the surgeon or assistant, such as shifting the view to the contralateral eye via the microscope’s handles or foot pedal, all without compromising sterility. Due to the proximity of the phone to the surgical field, both the surgeon and assistant could adjust the camera settings intraoperatively using a sterile gloved touch pen in a seated position [Video 2].

Figure 1.

(a) Overview of the magnetic neck mount. (b) Bird’s-eye view of the recording setup. (c) Intraoperative image captured with the built-in recording system of the surgical microscope in the right eye. (d) Simultaneous image using an iPhone with a magnetic neck mount in the right eye. (e) Images of the contralateral eye of the same patient using only an iPhone with magnetic neck mount

The Final Cut application was used for video capture. This app offers full manual control over focus, white balance, and exposure, minimizing issues such as flickering, glare, or autofocus shifts. Additionally, the Live Multicam feature, available on iPhone 14 Pro and later models, allows simultaneous multi-angle recording using up to four Apple devices and real-time monitoring via a compatible iPad (iPad M1 and later). An assistant can observe the procedure on the iPad and adjust all camera settings such as zoom and focus during surgery [Video 3].

The setup time for the recording system typically ranges from 3 to 6 minutes depending on the procedure’s complexity. For superficial surgeries (e.g., eyelid procedures), setup including mounting, positioning, connecting the iPhone to the iPad, and adjusting focus/brightness takes approximately 3 minutes. Deep-plane surgeries may require an additional 2–3 minutes for fine-tuning angles and lighting. Training OR personnel to use the Final Cut app on the iPad generally takes less than 2 minutes due to its simple interface. To address battery and storage limitations during long procedures, we used a multi-port adapter (Buff Labs Type-C USB 8-in-1 hub, South Korea) that allowed simultaneous connection of a charging cable and an external memory device to our phone (SanDisk 4TB Extreme Portable SSD, USA).

We also conducted a direct comparison between recording systems using the same patient undergoing levator surgery [Fig. 1c-e]. One eye was recorded simultaneously with both the operating microscope (The Med X Change HDMD™ All-in-One) and the smartphone mounted on magnetic neck mount, while the contralateral eye was recorded using only the smartphone-based system.

Over the past 6 months, we have recorded more than 50 procedures using this system including external dacryocystorhinostomy (DCR), orbitotomy, and various eyelid surgeries. None of the recordings exhibited decentralization or poor quality [Videos 4-6]. Screenshots obtained from these recordings clearly depict the operative anatomy with excellent resolution.

Discussion

A recent review ranked ophthalmology fourth among all surgical specialties in the number of publications related to intraoperative video capture.[2] Various methods have been described in the literature to address the challenges of recording oculoplastic surgery.[3,4,5,6,7] Nair et al. used an IV fluid stand, camcorder, and flexible tripod (Gorillapod), while Kimyon et al. employed a selfie stick and hose clamps mounted to the operating light.[3,5] Other alternatives including head-mounted cameras, loupe-attached recorders, and tripod-mounted smartphones are often limited by motion artifacts, ergonomic discomfort, and the inability to make sterile adjustments during surgery.[1]

The setup we describe offers multiple advantages: It is low-cost, easy to assemble, and highly adjustable. By securing the magnetic neck mount to the operating microscope and attaching the phone magnetically, we created a stable and easily maneuverable recording platform. This allowed for seamless intraoperative control via the microscope’s handle or pedal without requiring additional personnel.

Over the past 6 months, we have recorded more than 50 procedures using this system including external DCR, orbitotomy, and various eyelid surgeries. None of the recordings exhibited decentralization or poor quality [Videos 4-6]. Screenshots obtained from these recordings clearly depict the operative anatomy with excellent resolution [Fig. 1e]. Throughout these procedures, the device remained stable, with no instances of shifting or contact with the sterile field. The mount was applied preoperatively and was not adjusted after the surgeon scrubbed in, ensuring that sterility was never compromised. Depending on the complexity and type of surgery, different intraoperative adjustments may be required. For instance, bilateral procedures may necessitate repositioning the microscope handles to alternate between eyes, while deep-plane surgeries—such as DCR or orbitotomy—require careful angling of the phone toward the surgical depth to maintain optimal focus. Additionally, in cases involving excessive bleeding, reducing screen brightness can improve image clarity.

Capturing oculoplastic procedures using an operating microscope presents several challenges. The images recorded with the microscope [Fig. 1c] exhibited a limited field of view and were sharp only in the central region. Additionally, these images often appeared overexposed, with an overly white color tone. Fig. 1d shows image simultaneously captured using a smartphone mounted on the microscope via a magnetic holder. In this configuration, the microscope light served as the illumination source. Since the microscope was centered on the surgical field, the smartphone recorded from a lateral angle. While these smartphone-captured images offered a broader field and appeared clearer, they were affected by the yellowish hue of the microscope’s illumination, resulting in an overly reddish tone. In contrast, Fig. 1e shows an image from the contralateral eye using only the smartphone-based system, independent of the microscope. This image is markedly superior in terms of color accuracy, clarity, and field of view, highlighting the enhanced image quality achievable with our recording setup.

Advanced mobile applications can significantly enhance intraoperative video quality. The Live Multicam feature of the Final Cut Camera app enabled us to record from multiple angles simultaneously and monitor the procedure in real time on an iPad. This also allowed an assistant to adjust zoom, focus, and framing intraoperatively, further enhancing video quality without interrupting the surgical workflow. This technique proved particularly beneficial in long and anatomically complex surgeries, such as orbitotomies and reconstructive eyelid procedures where consistent framing and clarity are essential. While Android phones can also be used with the magnetic neck mount via magnetic-compatible cases, Live Multicam feature and full iPad integration remain exclusive to Apple devices.

Conclusion

Commercial accessories can serve as effective alternatives to expensive, medical-grade video recording systems, particularly in non-microscope-based ophthalmic surgeries. This innovative technique using a magnetic neck-mounted phone holder and iPhone provides a practical, affordable, and sterile-compatible solution for capturing high-quality surgical footage in oculoplastic procedures. We were unable to perform objective image analysis using tools such as ImageJ or MATLAB; further studies incorporating quantitative image analysis are needed.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.