Walk into most operating rooms built before 2015, and you’ll find the same setup: a hardware matrix switch bolted into an equipment rack, feeding a handful of displays through dedicated coax or SDI cables. This design served hospitals well for years. But surgical video has changed faster than the hardware built to carry it, and matrix switches are struggling to keep up.
Today’s ORs push 4K endoscopy feeds, C-arm imaging, patient vitals, and room cameras through the same infrastructure — often to multiple displays inside the room and outside it. Surgeons now expect to pull up a scope feed next to a PACS image on the same screen, stream a procedure to a lecture hall, or loop in a remote specialist mid-case. Matrix switches were never built for that level of demand, and hospitals are feeling the strain.
This is why more facilities are replacing matrix switches with IP-based video integration and understanding the difference matters before you plan your next OR build or retrofit.
How a Traditional Matrix Switch Works
A matrix switch is a physical hardware box with a fixed grid of inputs and outputs. Each video source — a scope, a camera, a monitor feed — runs through its own dedicated cable straight into the switch. The switch then routes each input to one or more outputs based on a hardwired configuration.
This model creates four problems that grow worse as your OR gets busier:
It hits a hard capacity ceiling. Every matrix switch supports a fixed number of inputs and outputs. Once you fill those slots, you can’t add a new camera or display without buying a bigger switch or a second unit.
It demands heavy, source-specific cabling. Each device needs its own dedicated run back to the switch. In a retrofit, that means opening ceilings and walls to pull new coax or SDI cable for every additional source, a costly, disruptive process.
It locks you into a fixed video standard. Matrix switches are built around the resolution and format available at the time of purchase. When your hospital moves to 4K endoscopy or a new imaging format arrives, you’re often looking at a full hardware replacement, not an upgrade.
It can’t reach beyond the room. Sending a live feed to a classroom, a control room, or a remote specialist typically requires separate dedicated infrastructure that a matrix switch was never designed to support.
How IP-Based OR Video Integration Works
An IP-based system removes the fixed hardware grid entirely. Instead of wiring each source directly to a switch, every camera, scope, and display connects to the hospital’s standard IP network through an encoder or decoder. Routing happens in software — any source can reach any display, anywhere on the network, without a single cable change.
Our Operating Room Integration system runs on this exact model, built on SDVoE (Software-Defined Video over Ethernet) hardware paired with the iVideo OR management platform. Here’s what that architecture delivers in practice:
It streams uncompressed 4K60 video with near-zero latency. SDVoE moves video at 4K60 (3840×2160 @ 60fps) with sub-frame latency — imperceptible during live surgery, where hand-eye coordination depends on real-time feedback. Compression artifacts, which can obscure fine tissue detail, never enter the signal chain.
It scales without new cabling. Adding a source or display means adding one SDVoE encoder or decoder to the existing hospital LAN not rewiring the room or upgrading a switch. The same 10GbE Ethernet infrastructure that already runs through most hospitals carries the video.
It future-proofs the investment. Because routing and control live in software, new devices, resolutions, and workflows can be integrated as they emerge, rather than forcing a hardware refresh every few years.
It extends past the OR walls. A feed can reach a lecture hall, a control room, or a remote specialist’s screen using the same network — no dedicated point-to-point run required. Paired with a platform like medVC, surgeons can stream a live case, record it, or bring in a remote consultant for real-time collaboration during the procedure itself.
It plugs directly into hospital IT tools. Since every encoder and decoder is a standard network device, your IT team can manage the system with familiar tools VLAN isolation, port monitoring, remote firmware updates, and centralized diagnostics instead of relying on a proprietary AV vendor for every change.
IP-Based OR Video vs. Traditional Matrix Switch: A Direct Comparison
| Factor | Traditional Matrix Switch | IP-Based System (Proscreen) |
| Video quality | HD (1080p) maximum | 4K60 (3840×2160) |
| Routing | Fixed hardware connections | Any source to any display, via software |
| Scalability | Requires a hardware swap to expand | Add encoders/decoders to the existing network |
| Cabling | Dedicated coax or SDI per source | Standard 1GbE / 10GbE Ethernet |
| Remote access | Not supported | Built-in remote monitoring and streaming |
| DICOM documentation | Manual transfer | Automated DICOM export via iVideoOR |
| Future upgrades | Hardware replacement | Software-driven, incremental |
When a Matrix Switch Might Still Work
A matrix switch can still make sense for a single, simple OR with a small, unchanging list of sources and no plans to expand, stream, or connect remotely. If your hospital runs one theatre with two cameras and two displays and never intends to grow, the upfront simplicity of a matrix switch is hard to beat.
That said, few hospitals stay static for long. The moment you add a second OR, plan a hybrid suite, launch a teaching program, or want to document procedures for compliance, the limits of matrix switching show up fast — usually as an unplanned capital expense.
Why Hospitals Are Making the Switch Now
Surgical video demand is only climbing. Minimally invasive and robotic procedures generate more video per case, hybrid ORs need to route imaging alongside live surgical feeds, and hospitals increasingly want to document, teach, and consult remotely without leaving the sterile field. Every one of these trends favors a network-based architecture over a fixed hardware grid.
Proscreen has deployed IP-based OR integration systems across NABH-accredited hospitals and government medical colleges in Delhi NCR, Mumbai, Bengaluru, and Chennai — retrofitting existing theatres and building hybrid ORs from the ground up, often without running new fiber or replacing existing Ethernet infrastructure. The same architecture also underpins Proscreen’s Mobile OR Integration solutions, which bring 4K streaming, near-zero-latency routing, and remote consultation to surgical setups outside the traditional hospital theatre. High-fidelity output depends on the display too — Proscreen’s surgical monitors are built to render that 4K 60 signal without losing the detail the camera captured.
Making the Right Call for Your OR
Choosing between a matrix switch and an IP-based system isn’t only a technical decision — it determines how easily your OR can grow over the next five to ten years, what a retrofit will cost when your needs change, and how well your surgical teams can collaborate beyond the four walls of the room.
If you’re planning a new OR build, a hybrid suite, or a retrofit of an aging matrix-based system, it’s worth mapping out where your hospital is headed before you commit to either architecture.
