If You're Thinking of Buying...Surgical Headlights

Today's surgical headlights offer a wide variety of options for light quality, fit, comfort and mobility. In addition to alternatives in the light source, headlights may be portable and even wireless. "Although a headlight may last indefinitely, the technology has really improved over the years. It's a good idea to upgrade," says Sanford Archer, MD, otolaryngologist at the University of Kentucky Medical Center in Lexington, Ken. We talked to the administrators who buy surgical headlights and the surgeons who use them. Here's a brief review of what's new and how these features will appeal to your surgeons.

Light sources: halogen versus xenon
Most headlights work with fiber optic light cords that carry light from two types of light sources to the headlight itself. These light sources use two types of lamps to provide the luminosity - halogen and xenon. Note that some halogen systems work without a separate light source. Here's a brief comparison of these two technologies.

• Halogen. Battery-operated halogen was once the standard in headlights. "When the halogen headlight first came on the market, it was like bringing the sun into the OR compared to the brightness of the incandescent lights we were using," says Dr. Archer.

The light generated from the halogen bulb provides a slightly yellow tinted illumination to the surgical field. "Although the halogen lights are not as white as xenon, they are very applicable in many surgical procedures," says Francis J. Collini, MD, cosmetic surgeon at the Renaissance Center for Plastic Surgery, in Shavertown, Pa. And, as the halogen technology has been around for many years, the cost of these lamps is considerably less than the xenon option of today.

• Xenon. Xenon systems offer bright, white illumination and cooler light. According to manufacturers, the heat that is generated stays at the light source and dissipates as the light travels through the fiber optic cable to the headlight. The alternative color of the light and heat variance may be more appealing to some physicians. "Xenon lights have been available for the last eight years. When they first came out they were very cost-prohibitive, especially for surgery centers. Over the years, technology has evolved and the lights have become more adaptable to surgical needs," says Dr. Archer. And, as with many technologies, while still slightly more expensive, the price has become more competitive with the older halogen systems.
• Light emitting diodes (LEDs). Your surgeons may soon be asking about LED surgical headlights. LEDs boast a lifetime of up to 50,000 hours (or 15 years of regular use) with virtually no maintenance and deliver a higher level of brightness than most fiber-optic headlights; by contrast, xenon bulbs last up to 1,000 hours and the fiber-optic cables or light carriers can degrade over time.

LEDs are said to provide surgeons with true color rendering of patient tissue. They operate without the glass and filament of incandescent lights. On the downside, LEDs cost up to 100 times more than halogen lamps in terms of the price per lumen emitted. The first LED headlight will be available this month when Visiled introduces its Halo Wireless Surgical Headlight, which the company claims is the first cordless headlight suitable for high-intensity surgical illumination. The Halo's design consists of two ultra-bright LEDs fitted onto a lightweight headband and powered with rechargeable batteries (batteries have a 4-hour charge and a separately available waistpack extends life to 9 hours).

Accommodating physician preference
The quality of the lights and comfort - that's what surgeons want more than anything else, says Diana Procuniar, RN, BA, CNOR, director of the Winter Haven ASC in Winter Haven, Fla.

"Headlights are subject to a great deal of personal preference," says Jay Klarsfeld, MD, an ENT surgeon and president of Advanced Specialty Care in Danbury, Conn. "They are not like endoscopes or video equipment that can just be compared quantitatively. Surgeons may wear a headlight for many hours to perform one or many procedures. In direct relation to this, the surgeon must feel that the headlight is comfortable while providing the light that best suits the needs of his procedure."

The surgeons and administrators we talked to rank the five most important features they look for in a headlight.

1. Brightness. All of our surgeons ranked brightness as the No. 1 feature to focus upon. Whether it's measured in lumens, lux or foot-candles, how the light illuminates in the surgical field is extremely important. More is better may not truly be indicative of the usability of the headlight. Comparing illumination numbers may not be enough. Brightness will vary not only between halogen and xenon lamps but also between halogen light sources themselves. "We recently trialed three vendors' headlight systems for our new ASC and I found that some comparable systems were noticeably brighter than others," says Dr. Archer. Most manufacturers will allow you an extended time frame - a 45-day demo, for example - to truly put their headlights to the test in your operating rooms. According to Dr. Archer, this is the best way to determine the headlight's ability to provide the type of illumination for your specific procedures and determine the comfort and usability of the head set.

2. Accurate color temperature. The color temperature, measured in degrees Kelvin (K), defines the hue of the light. It gives xenon (which measures about 6,000 K) its white, bluish light and halogen (measuring about 3,000 K) its yellow hue. While variations in color may not directly affect certain procedures, it does become an issue when the color of the light hue slightly distorts the surgical field and makes it difficult to identify blood vessels and nerve tissues. "I recently tried several new light sources and found that some were so bright that the reflected glare made it difficult to ensure good definition of the vessel and nerve structures within the operative area during my ENT cases," says Dr. Klarsfeld.

3. Comfort. "My procedures last anywhere from a few minutes to five or six hours in length. Older headlights used to get hot and uncomfortably heavy during my long cases," says Dr. Archer. Alternately, today's headlights are fashioned from significantly lighter materials and provide better tolerance for extended wear, helping to minimize the neck or back pain experienced from the older, heavier models. To guarantee comfort, look for a light that is lightweight and stays cool. In addition to the weight, the design of the light itself has been altered to promote less heat generation and adds to the physician's comfort. The headbands that position the light on the surgeon's head also come in a variety of materials, including options for disposable linings improving comfort and heightened hygiene for the users.

4. Multi-port turret. Accommodating all of your surgeons' preferences may be a difficult task when it comes to the actual headlight. You may find your OR equipped with a variety of designs. But your cost will be greatly reduced if you can get them to agree on one light source, either halogen or xenon. Once you achieve that, search for a light source that has a turret aperture to allow for multiple applications and adaptability and accommodates the different fittings of the fiber optic cables.

"Surgeons get used to using one kind of headlight. It's often the kind of headlight they were trained on," says Dr. Klarsfeld. "To accommodate these preferences, our center purchased one light source that is compatible with several fiber optic light cables. In doing this, we were able to accommodate the needs of the orthopedic surgeons and the ENT surgeons without purchasing more equipment than was necessary."

Keep in mind that in addition to the use of the light sources for the headlights, they may be used as alternative light sources for other light-carrying agents such as fiber optic cables for telescopes or lighted retractors, says Ms. Procuniar.

5. Infrared filtering. This isn't a deal maker or breaker, says Ms. Procuniar, but all surgical lights should have some kind of infrared filter to prevent infrared light from drying out tissue. According to manufacturers, halogen lights have lenses that deflect the infrared light. Xenon light cables will not transfer infrared filter.

Servicing your headlight
As with all equipment purchases, do your homework for warranties and future service before you buy. Dr. Archer suggests looking into the manufacturer's customer service department to find out if customer service is available 24 hours a day, seven days a week or only during standard working hours Monday through Friday.

Also, determine if the service includes returning the light source to the manufacturer or if the service is performed on site, says Ms. Procuniar. "A very important question to ask is if the company can provide you with a loaner in the event you must send your light source out for repair," she says. "Inquire about the costs you'll incur in addition to the repair such as shipping or travel charges."