A Bright Idea for Your ORs

Patient Safety

By: Joe Paone

Published: 4/15/2019

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Lighted instruments improve the surgeon's view in the deep, dark recesses of the patient's body.


Your surgeons might have the greatest training, the most accurate technique and work with cutting-edge equipment, but they can’t fix what they can’t see. Lighted instruments — retractors, suctions and drop-in devices — solve visualization issues deep within body cavities by letting surgeons focus bright light exactly where they’re working.

Lighted instruments have been around for a while, but their designs continue to improve. Surgeons now have the ability to choose between acquiring specialized instruments that have built-in lighting, or lighting attachments that fit to their existing instruments. They’re available in single-use and reusable versions.

Some new battery-operated instruments don’t require a corded connection to a power source. “Our colleagues in the colorectal surgery world have always had a retractor that comes with a light, but they had to plug it into a machine,” says Sam Siddighi, MD, chief of female pelvic medicine and reconstructive surgery at Loma Linda (Calif.) University Health. “There were wires, and you don’t always want to use something that’s tethered.”

The lighted instruments he uses, by contrast, offer complete freedom of movement. “I just attach the light to my retractors and use it during surgery,” he says. “It’s battery-operated, and you can move it from one retractor to another as needed.”

When Dr. Siddighi first began using lighted instruments, his lighted suction wasn’t optimal because it wasn’t as bright as he needed it to be. But his new tools, which feature brighter LED lights, have addressed that issue.

ENHANCED DESIGNS
New Headlights Are Worth Checking Out
HEADS UP If your surgeons are complaining about their surgical headlights, the latest options might address their concerns.

Surgical headlight designs continue to evolve to meet the needs of demanding surgeons. If you haven’t shopped the latest options, it might be time to take another look at recent enhancements that are making the devices more attractive and more user-friendly than ever.

  • Quality lights. Headlights that use LED technology run cooler, last longer and are more energy-efficient. LED lights, unlike yellowish halogen bulbs, emit a purer white light, which many surgeons prefer. They also render colors more accurately than even filtered halogen lights do — red in particular, which greatly aids tissue identification. Because of these clear upgrades, the surgical headlight industry has embraced LED. One criticism of LED lights, however, is that they can be so bright or blue that they can hurt the surgeon’s eyes, or cause glare. Another is upfront cost, which is higher than traditional lights — although you need to also consider LED’s vastly longer lifespan.
  • Freedom of movement. A major issue with surgical headlights has always been the need to connect them to a power source or light source box. That means the surgeon is tethered to a fiber optic or electrical cable, and that pesky wire might need to be carefully maneuvered around the table during a procedure. Some newer headlights have cut the cord entirely by using batteries or battery packs for power that are placed in scrubs pockets or attached to the headlight’s headband. That makes the headlight much more portable. On the downside, the batteries must be charged or replaced frequently, so having backup batteries charged and ready to go is a must.
  • Added comfort. A common complaint over the years from surgeons has been that headlights are not as comfortable as they should be, in terms of both the headband and the weight. Surgical headlights continue to make progress in becoming more comfortable, adjustable and lightweight.

— Joe Paone

“The brighter light makes the type of surgery I do safer because I’m able to visualize into really deep spaces, through the vaginal canal and beyond that,” says Dr. Siddighi. “I’m looking through this cylinder into this deep hole, and you need a lot of light to make sure you don’t place sutures on something that can be dangerous. So [lighted instruments are] good for both safety and accuracy. They’ve tremendously improved visualization into the deep spaces that I operate in.”

Marc Brozovich, MD, FACS, FASCRS, an associate professor of surgery at University of Pittsburgh Medical Center, is a general surgeon who performs a large number of colorectal surgeries. “Operating within the pelvis cavity is difficult enough as it is, without having difficulty seeing,” he says.

While he feels surgical headlights are useful, he prefers not to use them. “I don’t like wearing a headlamp — it gives me a headache,” he says. “Also, I find that the headlight is always a little bit off, where I’m looking isn’t where the light is, and I keep having to readjust it.”

Dr. Brozovich therefore uses lighted retractors and suction. He lauds their inexpensiveness, precision and illumination. The light is soft yellow or bright white, depending on the instrument he uses; he says both types of light are appropriate for his purposes and doesn’t express a preference, although your surgeons might.

One criticism Dr. Brozovich has of the lighted retractor he uses is that “it can get really hot where the light cord plugs into the lighted instrument, and at the tip of the light on the lighted instrument,” such that it could actually burn skin or tissue.

Overhead lighting can create shadows over the surgical site and, although it can be generally adjusted to different positions, it can’t be focused or intensified with exact precision over or into a very small or deep area.

Surgical headlights can greatly improve this situation, but they can have their own downsides. Headbands can slip or become uncomfortable, and older models can get hot, or require connection to a power source. Headlights also can cause the surgeon and staff to posture themselves awkwardly, which can lead to ergonomic issues and possibly even repetitive strain injuries. And they can be difficult to position as precisely as the surgeon may like. Overall, surgical headlights remain excellent tools, but they might not be as effective as some surgeons would like for deep cavity surgeries, while others may simply prefer not to wear them.

That’s where lighted instruments come into play. You have a lot of potential benefits to consider — precision, brightness, accuracy, lack of shadowing — and lots of products from which to choose. OSM

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