YOUR CHOICE Prospective buyers can expect a broad range of options and features — costs, too — in current surgical headlights.

Andrew Steinkeler, MD, DMD, has a constant companion for every surgical procedure: a battery-powered headlight given to him as a gift during his residency. "I never leave the house without it," says Dr. Steinkeler, a surgeon with Oral and Maxillofacial Surgery Centers in Warminster, Pa. "I use mine for every procedure and I will for the rest of my career. I love this light. It's a game-changer."

He's not alone among surgeons who heap glowing praise upon their surgical headlights. For surgeons in certain specialties — ENT, hand, oral and maxillofacial, and plastic surgery, to name a select few — a headlight is nearly as indispensable as a scalpel. And, given all the innovations of the past few years, they're likely to become even more essential.

Whether you're a first-time buyer or a veteran looking for an upgrade to replace "old faithful," you'll be amazed by the options and value-added features to help you gain the best possible view of the surgical field. Here's what to look for as you begin your search.

1. Light quality and intensity. The bulb option you choose — halogen, light-emitting diode (LED), metal halide, xenon — will likely be determined by the kind of surgery you do. Surgeons who do mostly "surface work" will be fine with a lower light output — a lower lux, as it's called — while general and spine surgeons will require a stronger, tighter beam with more focused illumination.

LEDs are today's "hottest" headlight technology, says Brian McLaughlin, MS, MBA, CCE, clinical engineering manager for perioperative services at Massachusetts General Hospital in Boston, Mass. As a clinical engineer, Mr. McLaughlin appreciates the cost and maintenance advantages that LEDs offer.

"The light is steady, and the degradation curve is more or less flat until the lamp fails," he says. "Some surgeons may prefer the high-intensity xenon lights versus LEDs, but in general you're seeing a move toward LEDs. The old-style lamps burn out much more frequently, and the intensity declines over time."

LED lights are also significantly cooler to the touch, making the surgeon more comfortable in the course of a long surgery. They also eliminate the fire risk from a light source, says Thomas Durick, MD, staff anesthesiologist at Freemont (Calif.) Surgery Center. "I once saw a surgeon who was doing a lap chole put [a light cord from a headlight] down for 4 seconds, and it burned a hole through the drape and the patient's gown."

2. Power source. You've essentially got 2 options here: tethered and untethered. Tethered headlights, which are connected by cables to an independent power source, provide maximum illumination and are relatively lightweight; at the same time, the cables have a reputation for fragility, meaning they may require repair more often than you would like. Compare that to the untethered battery-powered LED headlights, whose rechargeable battery packs can last a surgeon for a full day's caseload or longer.

"With the tethered options, you don't have to worry about battery life and it's easy to adjust the light intensity," says Jeffrey Blank, MD, a podiatric specialist and surgeon in Chicago, Ill. "But then you're also restricted if you need to move around."

If Dr. Blank were in the market for a new headlight, he would opt for a battery-powered unit because of the nature of his surgeries.

"When a hand surgeon sits down for a surgery, he's probably not going to move until he's done," he says. "With my field, when it comes to drilling, getting hardware and other factors that would require me to move around, the freedom and mobility of the battery-powered headlights would be more suited to someone like me."

3. Value-added options. Headlights have become multifunctional. For example, some headlights now have integrated cameras that let the surgery be projected onto surgical displays and viewed in real time both inside and outside the OR by other clinicians who are not in the surgical field. These cameras let surgeons take high-quality video and capture still images, which can be preserved and analyzed for future use.

4. Durability. Mr. McLaughlin says Massachusetts General's clinical engineering department "sometimes struggles" with maintaining the life of surgical headlights, particularly the tethered options.

"They get banged up quite a bit," he says. "We spend a disproportionate amount of time servicing headlights — the lens, the light cord, the camera, if there is one. Connections, in particular, are a challenge. You may often have a camera connecting to the camera box with a fairly fragile connector, so it can become easily damaged."

SAME VIEW Can you standardize surgical headlamps even if you offer multiple service lines?

5. Service and support. Our experts' advice: Seek out vendors that can provide as much help as possible in terms of product support, troubleshooting, product warranties or guarantees, and good deals on replacement parts.

"Our model is one of cost containment, where we're able to repair any broken equipment ourselves, so anything a vendor can do to help us accomplish that is very helpful," says Mr. McLaughlin. "We believe servicing our equipment on site provides the best turnaround time and uptime, so we like to work with manufacturers who are willing to work with us."

Vet vendors over their policies on trade-ins and warranties, as well as flexibility during trialing. This is especially important if you have service lines using older equipment and seeking an upgrade — say, headlights with video capability.

"We'll identify a couple of different products and ask those vendors to provide loaner equipment for a month or two so we can get a feel for how the surgeons like it," says Mr. McLaughlin. "We'll want to pass the headlight around and have as many surgeons as we can try it out."

6. Cost. Prospective buyers can expect a broad range. Dr. Steinkeler estimates his headlight cost $2,500. He intends to keep his current headlight "till it dies," he says, but when that day comes, he expects to spend about $2,000 on a replacement.

"You could spend $3,000 on nice battery-powered headlight, or you could spend $30,000 on a nice video-equipped unit with an independent light source," adds Mr. McLaughlin. "It's a function of the product the surgeons want that will help them the most."

Of course, cost includes more than just the per-unit purchase price. You'll also have to commit to the ongoing expense of replacement bulbs, parts and repairs, for example. As Mr. McLaughlin says, choosing a surgical headlight can be "a complicated formula sometimes." OSM