Working with a subpar headlight can really sour a case. If you're in the market for portable illumination, here are 5 factors that matter most to surgeons.

Brightness
First and foremost, I'm interested in how bright a surgical headlight is, how much illumination it distributes onto the field. You know immediately if a headlight's not bright enough. You're struggling to see, you have to keep adjusting the overhead lights or asking your partner to shine his headlight your way to complete the case. Those are precisely the inconveniences that headlights were intended to eliminate. The light should be even, from edge to edge, not bright in the middle and dimming on the sides. And the color of the light should allow you accurate visualization of the surgical site. A blue-white not only makes the subject look better than a yellow-white, but it's also easier on the eyes. When we trialed headlights, we literally held a head-to-head comparison. Two surgeons wore 2 different lights during a procedure and we asked the nurses and scrub techs which they thought looked brighter.

Control
The ideal light is direct and precise. You'll want a lamp that's easy to adjust and stays where you need it, not one that drifts and recoils after you've set it, as though it were returning to a set point. I've noticed that the different types of headlight bulbs allow different applications of their light. When you reduce the aperture on a xenon bulb, for example, the light's intensity increases as it focuses. But closing the aperture on LED lights doesn't provide a similar effect. For specialists working with smaller, tighter fields, such as ENT surgeons, this could be an important distinction.

Cords or cordless
In my view, the quality of light is far more important than whether your headlight is tethered to a light source and power unit, but it's still a consideration. Mobility is important to a surgeon. When you're in the OR during a case, you don't want to be anchored to the technology or pulled back by cords, and you don't want to wait even a few seconds for someone to disconnect and reconnect you. You just want to be able to move. But, on the other hand, heavy battery packs clipped to your waist can be a hindrance, too. However, a suitably light battery pack or a suitably long, lightweight cable can make a big difference for a surgeon seeking the freedom to move in his OR.

Comfort
Without question, your surgeons will need to try on headlights to get a feel for their weight and comfort. Does the cooling apparatus that some headlights include make them heavier or unwieldy? Does the device create pressure points that you'll have to pad with gauze during every use in order to avoid soreness or irritation? The ideal headlight should feel like a comfortable hat.

Longevity
When you're selecting the headlight that works best for your physicians, be sure to find out how it performs over time. A new headlight is bright, but does it stay bright? This is a function of the type of bulb it employs (xenon bulbs tend to gradually lose intensity over time and require replacement, while LED light maintenance usually involves replacing the battery) and the use and handling it's subjected to (the fiber-optic threads in the cord connecting a headlight and light source will break, little by little, causing a gradual loss of intensity).

Your surgeons should take note of the different types and ages of headlights used during their visits to other facilities. They'll often be able to tell which ones are newer and how well the devices hold up over time.

Applied Fiberoptics
Gemini Plus
www.vitalcor.com
(800) 874-8358
Price range: $1,500 to $2,000
FYI: The Gemini Plus is an upgrade over the original Gemini headlight. Its advances include a spot size increase in size to 140mm and improved optics that create a brighter light regardless of the light source. The encapsulated, ultra-low-profile design doesn't interfere with surgical loupes and lets surgeons work closely without bumping headlights. The Gemini Plus weighs 8 oz. and features 2 red, easy-to-use controls for spot size and lens adjustment. The sweatbands inside are easy to remove and replace.

BFW
Thru-the-Lens Headlight Video Imaging System
www.bfwinc.com
(502) 899-1808
List price: not disclosed
FYI: Combining surgical headlight and image-capture technology, the Thru-the-Lens Headlight Video Imaging System positions the single-chip video camera directly in the center of the headlight optic for consistent coaxial alignment of the camera to the light. BFW's ChromaLume solid-state plasma light source delivers 10,000 hours of lamp life and the camera provides an extended depth of focus to keep the image sharp regardless of inward or outward movement from the field. The system includes a 10-foot fiber-optic cable, camera control unit, light source and mobile stand.

Cool-View
Model 1400 XL
www.cool-view.net
(866) 961-6441
List price: $4,595, with quantity and GPO discounts available
FYI: Cool-View's Model 1400 XL headlight uses energy-efficient light-emitting diodes (LEDs) with 50,000 hours of illumination life, which eliminates the need for replacing bulbs, lowers operating costs and reduces waste. The headset weighs less than 4 oz. and produces no heat, offering a comfortable system for surgeons to wear, and its bright white light matches natural daylight for ideal color contrast and less eye strain. Two rechargeable lithium-ion batteries, each with a 4-hour life and a 30-to-90-minute recharge, provide users with virtually unlimited use and untethered mobility.

Designs for Vision
LED DayLite Twin Beam
www.designsforvision.com
(800) 345-4009
List price: $1,795
FYI: The LED DayLite Twin Beam's patented design optically collimates the light of 2 LEDs for brighter illumination. The untethered system provides surgeons with mobility and its LEDs eliminate the need to replace bulbs or fiber-optic cables. It runs on a 3-cell lithium-ion battery for 4.5 hours of power, and the 2 batteries supplied with the unit can be linked together for 9 hours of continuous use. The system is available with either the DV headset or coaxial headset, and the blue cable ensures shielded protection from electromagnetic current for safety.

Enova Illumination
Iris D-200
www.enovaillumination.com
(651) 236-8858
List price: $1,000 to $3,000, depending on model
FYI: The brightest of Enova's 3 LED surgical headlight systems, the Iris D-200 shines 200,000 lux at 14 inches, providing optimal and precisely focused illumination for deep cavity surgery. The pure white light renders tissue color accurately and consistently with no light degradation to prevent eye fatigue. With no bulbs or fiber-optic cables to replace, the company estimates an annual savings of over $1,000 in maintenance costs. An ergonomically balanced device made portable by belt-mounted lithium-ion batteries with up to 12 hours of charge, the Iris D-200 lets users move without the restraint, weight and heat of cables or light source units.

Heine USA
LED MicroLight
www.heine.com
(800) 367-4872
List price: $2,054
FYI: The Heine LED MicroLight offers a quality alternative to restrictive or uncomfortable headlights without sacrificing performance. Compact and lightweight, the ergonomic, frame-mounted headlight is designed to optimize surgeon comfort. Its high-performance LED technology combined with precision glass optics to guarantee an exceptionally white and homogenous illumination of the entire field of view. The individual adjustment of lamp height and angle of view enables healthy head and back posture while providing 100% coaxiality for shadow-free light. The included battery pack allows unrestricted movement and up to 17 hours of continuous "on" time.

Integra Surgical
LED Headlight System
www.integralife.com
(800) 431-1123
Price range: $6,000 to $8,500
FYI: Integra Surgical's LED Headlight System offers vibrant color rendition that maximizes the visualization of critical anatomy across a broad range of surgical procedures. Its 25,000-hour-plus lamp life limits uncertainty by ensuring your surgeries will always be illuminated. Its whisper-quiet cooling system provides comfort for the wearer. The system also provides freedom with either a lightweight, 20-foot power cord that eliminates the clutter of floor stands and fiber-optic cables or a lightweight battery for untethered mobility around the OR.

Luminance Integrated Technologies
ONE HeadLight
www.litsurgical.com
(972) 424-3894
Price range: $4,350 to $6,500
FYI: The ONE HeadLight, a 36-watt, solid-state surgical headlight, combines power and mobility to deliver high light quality and output with virtually no maintenance costs, as it has no bulb or fibers to replace. Its patented Optical Navigation Engine (ONE) technology broadcasts a homogenous beam of light that is optimized for surgery and provides accurate color rendering, eliminating unwanted ultraviolet and infrared light from the projected beam. A patented thermal exchanger enables maximum light output without heat buildup.

SurgiTel
Mini LED Headlight
www.surgitel.com
(800) 959-0153
List price: $995
FYI: SurgiTel's Mini LED Headlight is compact and lightweight — about the length of a paper clip and only 4 ounces — for direct mounting onto a loupe or frame. But within this small device is a powerful, reliable, portable light source. The 3-watt LED delivers an adjustable in size, but sharply defined and high-intensity, light beam. The lithium-ion battery, about the size of a deck of cards, provides 8 hours of power. And the unit integrates seamlessly with SurgiTel's precision telescopes and loupes.