Just a few years ago, when only a couple of manufacturers were promoting LED lights as the next wave in surgical illumination, I advised potential buyers to proceed with caution, as I wanted them to be certain that the technology would support the rigorous demands of surgery the way that traditional incandescent-bulb lights had for decades. Today, the brighter, cooler, more cost-efficient LED lights are clearly the preferred choice for facilities installing or replacing their OR lighting systems. I expect the demand will continue as more people see them in action at conference exhibit halls and on site visits. Here's how to decide if LED lights are right for you.

Cost versus benefits
Perhaps the only disadvantage associated with LED surgical lighting is that the cost of the newer technology is higher than that of traditional OR lights. While pricing varies depending on a facility's purchasing contracts and GPO participations, LED lights may list for 20% to 30% more than bulb-driven lights.

Admittedly, that difference can take a big bite out of your budget. Keep in mind, though, that while the initial cost of LED lights may seem hard to justify, their operational costs are money-savers over the long term in comparison to traditional lighting.

Energy efficiency is one such advantage. An array of light-emitting diodes uses much less electricity than high-powered incandescent light bulbs do. So LED lights reduce your power consumption, utilities bills and environmental footprint — a consideration that's really taken off in the surgical industry in recent years.

Longevity is another advantage. Some manufacturers claim that their LED lights currently on the market have a working life of as long as 30,000 hours. Few, if any, of these products have been around long enough for us to know if that projected lifespan is accurate. But we do know that their arrangements of hundreds of small, solid-state, semiconductor devices can last longer and are more reliable than the filament in a bulb. As a result, the technology practically eliminates the interruptions and delays caused by burned-out bulbs as well as the need to buy, stock and replace bulbs.

Given the current economic climate's effects on capital equipment buying, manufacturers are fighting for market share and may be more amenable to negotiations at the point of purchase. Buyers may be able to score some bargains, if not in price then perhaps through such creative offerings as an extended warranty, a longer service contract or repair training for your biomed staff, which can save your facility money over the long term.

Berchtold
Chromophare E Series LED Lights
(800) 243-5135
www.berchtoldusa.com
List price: $25,000 to $65,000, depending on configuration.
FYI: Berchtold's Chromophare E Series of surgical lights now include 2 LED-powered options, the E 778 and the E 558. Each model features bright, low-heat illumination; smooth, bright, uniform spots; standard color temperature adjustment and an easy-to-maintain design with interchangeable LED pods and no moving parts. A 25,000-hour bulb life makes Berchtold's E LEDs virtually worry-free, so the surgeon and surgical staff can concentrate on the patient, not on the light.

Maquet
PowerLED 300
(888) 627-8383
www.maquetusa.com
List price: $15,000 to $45,000.
FYI: Slim and lightweight, Maquet's PowerLED 300, part of its PowerLED line of surgical lights, is engineered for easy positioning and simple, plug-and-play application. Like all the PowerLED lights, the 300 features "always-in-focus" illumination with an exceptional depth of field and volume of light. It provides consistent illumination output through its exclusive Flux Stability Program and shadow control through its specially designed Fresnel lens technology. It has a 40,000-hour service life and consumes up to 50% less power than halogen lights.

Lights on site
You can contact a reference list of previous buyers to ask about their experiences with a particular model of LED lights. You can also see the illumination and try them out yourself in conference exhibit halls, vendors' show rooms or other surgical facilities' ORs (preferably when company representatives are not around).

But as with any major capital purchase, there's no substitute for temporarily installing the lights at your facility to find out how they'll work in your own OR and to give your physicians and staff some sustained hands-on time with them. This is not, after all, equipment that's going to be replaced every few years.

Whether you're outfitting a new OR or renovating an existing one, you'll have to determine how suitable the room is for the overhead lighting systems you're considering. From a practical standpoint, this determination isn't much different for LED lights than it would be for traditional lights.

You'll need to look at your building's structural support above the OR ceiling (manufacturers will be able to tell you what is required), because sturdy support not only keeps lights securely mounted but also adds stability in positioning. This prevents lights from drifting and requiring readjustment whenever the HVAC ducts vibrate, for instance. In California, where I do a lot of consulting, there are also seismic safety requirements to satisfy.

When planning lighting placement, it's essential to compare the height of the ceiling and the location of the OR doors — hence the workflow to and around the surgical table — with the sizes and shapes of the lights you're considering. That way, you'll know if there will be adequate headroom for your surgical teams when the lights are installed. Another advantage of LEDs is their compact shape as compared to the big rounded bowls of traditional lights. It's like the difference between cathode ray tube monitors and the flat-panel monitors that have been replacing them.

Given the increases in OR size and technology, it's also advisable to plan ahead and coordinate the interactions of your overhead lights with other ceiling-mounted equipment — such as booms, flat-panel monitors or cameras — that you have or are planning to install. For obvious reasons, you want to make sure that each can move freely and operate effectively without too much conflict or collision. If you're purchasing hybrid equipment from a vendor — combination OR lights and equipment boom, for instance — this won't be a concern. But if it is, most manufacturers offer computer-generated, 3-D models of your OR to demonstrate the placement of equipment.

Steris
Harmony LED Lighting and Visualization System
(800) 548-4873
www.steris.com
List price: $26,000 to $28,000 for dual-light system.
FYI: Steris's Harmony system offers high-performance optics that provide 160,000 lux of light intensity; exceptional deep-cavity illumination; a crisp, adjustable spot size and excellent shadow control, says the company. Not only does the Harmony system deliver powerful, natural white light, it has also optimized its color-rendering index to allow users to better visualize the subtle shades of red in exposed tissue with clarity, comfort and focus. Its lenses are meticulously fitted, precisely aimed and overlapped to achieve a tight, round pattern and eliminate distracting shadows.

Nuvo
Verde Surgical Lights
(800) 663-1152
www.nuvosurgical.com
List price: $13,275 to $35,225, depending on configuration and accessories.
FYI: Nuvo's Verde lights offer advanced and upgradeable LED technology with environmentally friendly energy efficiency, says the company. They feature a "green light mode," which dims the room to enhance the endoscopic surgeon's ability to view his monitors while providing sufficient light for other OR personnel to work by. The Verde 3 model generates 130,000 lux of light and the Verde 4 model generates 160,000 lux. Each model incorporates Nuvo's patented autoclavable control handle, shadow management function and a 5-year warranty.

Skytron
Aurora II Hybrid LED Surgical Lights
(800) 759-8766
www.skytron.us
List price: $15,100 to $40,100, based on choice of single-, dual- or triple-lighthead option.
FYI: Skytron's Aurora II is driven by its high-performance, Hybrid LED optical system, says the company. Dynamically focusable, high-intensity LEDs provide adjustable deep-cavity illumination, while centrally positioned, fixed-focus LEDs produce a bright column of light. The combination of focusable and fixed light sources delivers quality, shadow-free illumination for every procedure. The Aurora II also offers surgeons the ability to adjust the light's color temperature, including 4,000 ? K soft white or 4,500 ? K bright white settings, to better suit different procedures.

Stryker
Visum LED
(877) 789-8106
www.stryker.com/communications
List price: $29,507 to $51,845, based on configuration.
FYI: Stryker's Visum LED surgical light integrates light-emitting diode technology into its unique Visum multi-reflector design to produce light that is starkly cool while also providing a combination of brightness, pure whiteness and shadow resolution, says the company. The Visum LED is available in single as well as dual configurations, and also features an optional in-light camera with zoom capability to provide overhead visibility to all surgical personnel as well as remote viewers.

Hands-on use
The compatibility of a lighting fixture with the dimensions of a surgical space is one thing, but the compatibility of that light with surgical personnel is quite another. You'll want to keep a temporarily installed light on site for trials for at least a couple of weeks. It won't take that long for surgeons and staff to decide if it works for them, but you'll want to allow sufficient time for all of your OR personnel to weigh in on the new lighting.

One of the first things to impress new users of LED lights is how little heat they generate as compared to traditional bulb lights. When you're draped in gowns and gloves under the lights, particularly for long cases, the cooler light is a comfortable benefit. Another noticeable benefit is the light weight of the fixtures, which makes them extremely easy to maneuver and position. However, surgeons, nurses and scrub techs should take note during trials of how well the lighter fixtures stay in place once positioned, so as to avoid the annoyance of having to reposition them many times throughout a procedure if they drift.

In terms of light quality, your physicians will have an eye on whether the light is bright enough, the size of the spotlight it projects and how precisely it is able to focus on a surgical site. LED lights are said to illuminate their subjects' true colors more accurately than bulb lights can. By benefit of their multiple arrangements of small light sources fixed at different angles, they also minimize shadows for a more consistent light, even when surgical personnel lean into the spot.

For facilities that see a high volume of endoscopic procedures, which require a darkened OR for monitor visibility, an indirect lighting mode is a useful option to seek out on an overhead lighting fixture. This feature provides a setting through which a small number of bulbs can supply ambient lighting to other personnel beyond the surgical site during a minimally invasive procedure's dimmed conditions. For anesthesia providers monitoring and taking notes at their work stations, and for nurses and scrub techs selecting medications or instruments at the back table, an indirect lighting feature contributes to greater patient safety.

As with any surgical equipment purchase, the availability of technical support and how quickly the manufacturer can provide it when you need assistance is an important issue to raise among other owners with whom you may come in contact. Since LED lights are still a relatively new technology, you'll also want your biomed staff to do their due diligence on any potential service issues, recalls or failures involving the models you're considering since they've been released. LED lights seem to be reliable pieces of equipment, but superficial flaws can have a big impact in the OR. One vendor, for instance, had to recall a fixture due to paint that chipped off of it upon impact with other equipment. That's an important side effect to avoid, considering a light's front-and-center positioning over a surgical site.

Trumpf Medical Systems
TruLight 5000
(888) 474-9359
www.us.trumpf-med.com
List price: not disclosed.
FYI: Trumpf, the company that pioneered LED surgical illumination with its iLED line of lights, promotes its new TruLight 5000 as an energy-efficient addition to the line. The 150,000 lux light features a 20,000-hour service life, minimal power consumption and advanced heat management and lighting control in a compact, easy-to-position design, says the company. Light intensity can be electronically adjusted to suit the distance between the light head and the surgical site, and a new optical lighting system produces a homogeneous spot at any distance.