Quality lights and tables vital to successful outcomes

by Curt Werner

In the operating room, every surgical procedure demands the skill and the concentration of the surgeon and the surgical staff. The work calls for the ultimate in teamwork. But right alongside those men and women in the O.R. are some pieces of equipment that can be just as critical to patient care and positive outcomes. That equipment, which can be overlooked among the tangle of surgical tools at the physician’s disposal, includes operating room tables and the lighting that surgeons use to help guide their deft movements.

Chiefly because a sales representative can make a single contact point on a sales call, the four leading suppliers that show the way in these two segments offer both lighting and table products. The four include Berchtold Corporation, a German-based manufacturer of lighting since 1929 with headquarters in this country in Charleston, SC, Getinge Inc., a multi-national concern with a U.S. base in Rochester, NY, Skytron, Grand Rapids, MI, and STERIS Corp., Mentor, OH. Though Berchtold is a lesser player in the tables market, together these four dominate U.S. surgical light and table sales, and post significant offshore sales figures as well.

Market researchers estimate the overall U.S. surgical lighting market at between $75 million and $95 million, and growing at a rate of between 3 percent and 5 percent annually. The market for lighting installed in U.S. surgicenters is growing faster at 15 percent CAGR. However, that market generally requires smaller, lower-priced items than those found in most acute care institutions. The U.S. surgical table market is estimated at between $80 million and $100 million with a 4 percent to 5 percent compound annual growth rate.

As for market share, the four leaders are essentially alone at the top. At least one estimate places Skytron in the lead of the fixed, focused lights segment with a 30 percent share, followed by STERIS and Getinge’s ALM brand at 25 percent. Berchtold comes in at approximately 20 percent. Skytron, which has made a concerted effort in the segment, says it holds 85 percent of the newer and smaller focusable lighting segment. The overall U.S. tables market, which is dominated by only three companies, is more difficult to pin down, though best estimates place STERIS in the lead with a 40 percent share, followed closely by Skytron at 35 percent, with Getinge’s Maquet line coming in third with an estimated 20 percent share.

O.R. lighting shows the way
For the casual observer, it would be easy to miss the importance of highly accurate, glare-free, steady light in the operating room, but surgeons certainly don’t. Neither do the manufacturers of modern lighting systems. “Next to the surgeon’s eye, lights are the most important tool they use,” says Randy Tomaszewski, Skytron’s vice president of marketing. “Surgeons need high-intensity light that produces no shadows and is bright but not too bright so they’ll see spots. They need a soft light that has the ability to cover a great range without lots of moving and repositioning. These needs are especially important in deep cavity work such as orthopedics and cardiovascular procedures where a quarter-turn of a handle is most efficient.”

He says that Skytron, which has produced O.R. lighting products since 1972, has succeeded in a relatively short time by providing lights that meet the demands of today’s surgery. “The bottom line is the quality of the light.”

Skytron has forged ahead with successful lines of focusable lighting and the company has become the top provider of focusable lighting systems, units that provide surgeons with direct focus and variable depth of field control over a wide range of working distances, while retaining 90 percent of their maximum intensity at any distance. The Skytron Stellar Series yields high-intensity, soft-white lighting with advanced focusable optics that have optional voice command and touch screen features. In addition, portable handle-mounted Sony-made surgical cameras are available with Skytron lines. Skytron systems are designed to provide high-quality, high-resolution video images for recording surgical procedures and/or for clinical teleconferencing.

The voice command and touch screen features can be important in certain settings, Tomaszewski says. Such features give surgeons more control, making them less dependent on nurses for every move. “If a hospital does a good job of matching their surgical teams to future technology integration, they can plan a few rooms with this technology now and go forward and add more of these systems later,” he says.

Getinge, meanwhile, offers lighting products through its ALM and Hanau Med brands, the latter being the renamed former Hereaus Medical, a name change that was announced late last year. Bob Von Kaenel, Getinge’s vice president of marketing, says the construction and renovation market is driving lighting sales for his company. “Plus, it’s an issue of technological integration,” he says. Echoing the perception at Skytron, Von Kaenel says hospitals are asking to integrate more technology into their lights such as voice and video camera. “Hospitals are approaching lighting as a visualization package, not just lighting,” he says.

In addition, Getinge’s lighting lines acknowledge the growing popularity and acceptance of minimally invasive surgical procedures that are being used in more areas than before. Those procedures are accompanied by shifting surgeon demands. Says Von Kaenel, “It’s a different approach than with open surgery. Just five years ago lights were the prime visualization product. But now, lights are supplements that tie into overall lighting systems.”

Both men report stable pricing in most lighting categories, mostly due to increasing competition between the suppliers in a physician preference-driven (and O.R. manager-driven) product such as surgical lights. Prices are said to be within 10 percent to 20 percent of each other. For example, a typical dual lighting system would cost a hospital between $20,000 and $22,000, though a larger system used in cardiovascular procedures might carry a $25,000 price tag. Group purchasing has had some effect on discounting, though since of necessity most portfolios are packed with multisource agreements, and with a variety of product configurations available, the GPO impact may be somewhat diminished. 

Tipping the scales in favor of O.R. tables
As with most other hospital product markets, the surgical tables market in the U.S. has evolved in recent years to reflect changing demand. “U.S. hospitals are demanding more functionality in their tables,” says Getinge’s Von Kaenel. “They want a blend between surgical and non-surgical functions such as radiology and they want more integration and the ability to do more and different procedures with the same table.” That demand for shorter set-up times stems from the need for hospitals to turn around surgeries as quickly as possible for both patient care and financial reasons.

Although relatively minor advances in O.R. table technology such as voice activation and touch-screen control are generally available from most suppliers, another development is placing new demands on manufacturers of surgical tables. That change is the increasing weight of the American patient. The bariatric market niche is driving growth for table producers. “Fifteen years ago,” says Von Kaenel, “we would sometimes see patients weighing 300 pounds. Today, it’s not uncommon to have patients weighing 500 pounds.” 

Skytron’s Tomaszewski, who says that his company’s 6500HD surgical table is the leading bariatric table today, reports that surgery on a patient weighing an astonishing 1,200 pounds was performed recently using a Skytron product. Prior to the development arge patient would have to be performed on two tables joined as one. It’s not surprising then that, sensing a growing marketing opportunity, hospitals have begun opening for-profit bariatric centers to treat a rising population of morbidly obese patients.

Regardless of the size of a patient, ease of positioning is one of the most important characteristics of any table. It is a difficult and frequently delicate chore to move patients safely during a surgical procedure. Skytron’s 3500 Series table, for instance, can rotate 180 degrees if necessary, which happens when the need occurs for better positioning of a C-arm.

When the time comes for a hospital to purchase more tables, they will have to be ready with as much as $34,000 to pay for a general surgery table or as much as $36,000 to $45,000 for a specialty table. Hefty price tags indeed, even if market players report flat pricing mostly due to tough competition. But a quality surgical table like the products sold by the market leaders will typically last as long as 15 years (Tomaszewski says that a 25-year-old table recently came back as a trade). Some hospitals turn to the refurbished market, but by and large quality reigns and the refurb products more often end up in physician offices, though Skytron says its products are just as often sold back to U.S. hospital customers eager to keep a reliable, yet older table. 

Says Tomaszewski, “Hospitals that go for quality want and will get a table that won’t end up sitting in a hall somewhere with a red tag on it.” HPN

HPN

April