X'Ten from Getinge

When envisioning a state-of-the-art surgical suite, high-tech instruments, cameras and monitors are among the first images to come to mind.

While such pieces of equipment are deservingly capturing the spotlight and are indeed critical to the success of today’s cutting-edge procedures, their effectiveness — along with the surgeon’s — hinges on another OR staple: surgical lighting. After all, what good is an instrument and technique if a surgeon’s line of vision is overshadowed by a less than stellar light source?

Surgeons understand the importance of quality lighting and are placing a greater emphasis on acquiring systems that not only provide effective illumination, enhanced integration, and shadow and heat reduction, but can meet the critical needs of others as well.

Stryker’s E-Boom HZ

"There are many different factors driving customer purchases today. While surgeons will focus primarily on the [quality of] illumination, nurses will generally look for lights with good maneuverability. Those in purchasing will look at a lighting system’s cost-effectiveness," explained Pam Rockow, product marketing manager, lighting and visualization systems, Getinge USA, Rochester, NY. "Having the ability to meet all those needs is critical."

Manufacturers of surgical lighting systems are doing just that by offering innovative products that are more versatile, customizable and upgradeable — and compatible with other equipment in the surgical suite. The goal, sources told Healthcare Purchasing News, is to enhance not only visualization, but also overall value.

"Recent innovations have included the development of a systems approach to lighting, as compared to just having a ‘light.’ The technological developments for surgical environments have been driving innovation that integrates multiple functions into advanced surgical lighting systems," noted Jim Norris, product manager of surgical lighting and visualization systems for STERIS Corp., Mentor, OH.

"These systems provide excellent lighting in combination with videography, cameras, automation and flat panel monitors, for example," Norris said, adding that some systems are also integrating technology that provides minimally invasive surgery-to-open surgery versatility and ambient lighting in the OR.

Building on the basics
When purchasing major surgical lights, vendors generally agree that, first and foremost, customers seek those that can deliver a high intensity, soft white light, along with true color, low heat, and minimal glaring and shadows. Having a range of lighthead options available – from single, double and triple configurations that can be used in wall, ceiling or stand mounts – are also factored into the purchasing decision, as are enhanced rotation and maneuver- ability.

Medical Illumination’s System OneOrbita

Though such requirements are nothing new, the way surgical lighting manufacturers are addressing them is. In regard to illumination, many vendors are offering lights that far exceed the 100,000 minimum lux (at a distance of one meter from the light source) requirement set forth by the Illumination Engineering Society of North America. In fact, depending on the technology and configuration used, some lights provide more than 400,000 lux and require lower watt bulbs that generate less heat.

Skytron’s Stellar Series focusable lighting system, for example, features a multi-lamp design that provides surgeon focus control and extended, variable depth of field over greater working distances. Stellar Series lights also offer high intensity (up to 420,000 lux for triple lightheads and 290,000 for dual lightheads) and cool beam temperature. The company’s fixed focus lighting systems offer intensity up to 193,600 lux, and its Millennium Gold Series features fixed focus optics and a single lamp source with an automatic reserve bulb. The Millennium Series comes in three lighthead configurations and provides intensity up to 360,000 lux. Stryker’s VISUM Surgical Lights provide high intensity from a low wattage bulb, along with an aluminum hood for optimum heat dissipation and low heat generation down to the surgical field.

As more surgical procedures become minimally invasive, vendors have met the unique lighting needs by offering a ring of LEDs that offer minimal lighting. Ambient lighting improves screen vision, reduces eye fatigue, and is also ideal for preparation before and assistance during surgery.

"This lighting offers enough illumination for MIS, but eliminates the blaring light of [major surgical lights]," explained Rockow, adding that Getinge’s newly launched ALM X’Ten surgical light features a built-in ring of LEDs with four presettings of 30, 70, 100 and 150 lux.

The X’Ten’s ring of LEDs is located right at the lamphead, providing easy access that allows the surgeon to quickly switch to major surgical lighting if an open procedure is necessary, Rockow explained. The X’Ten also features a cross-shaped lighthead that allows lightbeams to be directed around the surgeon’s head, avoiding potential shadows.

Gas discharge technology has also become more prevalent in recent years. These lighting systems offer theoretical longer bulb life and emit light by ionizing a canister of gas, as opposed to heating a filament. Gas discharge systems operate on only a 70-watt, low-heat bulb, yet give off high-intensity, 160,000 lux illumination. Gas discharge technology is at the heart of Berchtold’s Chromaphare Lighting System, as well as Trumpf’s Xenion lights.

Other advantages of today’s lighting systems include more lightweight, durable designs, enhanced maneuverability and less drifting, and 360 degree rotation for greater flexibility, positioning and control. Vendors are also turning their attention toward ergonomics, offering easily accessible positioning handles and controls, and more adjustable systems that offer greater downward and upward illumination to accommodate surgeons’ varying height requirements.

An eye on integration
In an ongoing effort to maximize value, as well as floor and ceiling space, facilities are placing a greater emphasis on acquiring lighting systems that can be easily integrated with other surgical equipment – and even upgraded to meet the future needs of the organization.

Getinge’s Energix (with screen)

Manufacturers have responded to that need with lighting systems that can be integrated with video and monitoring equipment, ceiling-mounted booms, in-light and independent cameras, and routine control equipment, for example.

"We’re seeing more development in regard to suspension systems, with more cameras and multi-media being integrated into the suspension system to allow for [Picture Acquisition and Communication Systems] in the OR," explained Rockow. "Having the ability to integrate all those different signals has become increasingly important."

All of Stryker’s lighting suspensions come standard with five pole commutators at all 360 degree rotational points, which Anderson said allows for "cleaner data and video signal transmission." The company also offers lights with integrated 30X zoom cameras that can be controlled from Stryker voice activation and control devices.

STERIS has taken a multi-faceted approach to integration. The advanced suspension system of the Harmony LA System supports all visualization components needed and allows the flexibility to use a single operating room for multiple procedures.

"Surgeons will continue to demand flexible lighting systems that can be configured for optimal visualization of any procedure, including procedures requiring camera systems, flat panel monitors and minimally invasive surgery automation systems," Norris said. The Harmony LA System allows the surgeon to use any size Harmony LA lighthead, integrate ambient lighting and attach a DeepSite Fiber Optic Light for deep cavity cases. Two flat screen or full size CRT monitors can also be attached, and surgeons can use the integrated lighthandle camera for video documentation and teaching. STERIS’ WaveLens technology also allows users to adjust the light pattern without losing focus.

Having the ability to integrate seamlessly with endoscopy equipment has also been a priority for STERIS. The company has forged agreements for co-development with vendors such as Karl Storz Endoscopy, Stryker, Smith & Nephew, Olympus and ConMed.

"We designed our Harmony systems with input from all the major endoscopy vendors and integrated that information into the design process. This resulted in a visualization system that will be capable of integrating future technologies," said Norris.

Getinge has taken a "build as you go" approach with its systems, enabling customers to integrate different components over time – an approach that helps keep expenses and downtime to a minimum, according to Rockow.

"Our cameras are actually integrated into the handle of the lighting system, which means customers can add the cameras easily, and with minimal downtime in the OR" she said. "The same goes with mounting equipment. We work with our customers to determine their growth plans and then come up with a system that will accommodate their needs now and in the future."

While many facilities prefer to partner with a vendor that can help them standardize their capital equipment purchases by offering a complete system – from surgical lights and video components to cameras and routing devices – other facilities may opt to maximize their savings by shopping around for more cost-effective lighting systems that can be integrated into other manufacturers’ equipment.

NUVO Surgical Inc., Erie, PA, Burton Medical, Chatsworth, CA, and Medical Illumination Inc., San Fernando, CA, all tout surgical lighting systems that deliver powerful performance and integration capabilities at a more competitive price.

According to Larry Debord, vice president of sales and marketing for Medical Illumination, the cost-conscious healthcare industry requires a cost-effective solution for all medical equipment, with surgical lighting being no exception.

"You don’t have to sacrifice quality for cost. There are quality lighting systems at a great value that can be integrated with other equipment. If you are selective and do your homework, the savings can be great."

Still, Debord acknowledged that many higher-priced lighting systems include more value-added services, such as a "cradle to grave" customer service approach that covers everything from major repairs to simple arm adjustments and bulb changes.

"This level of value-added service is great, but it does come with a price. Some customers may want that Rolls Royce of service, but others may need to be more cost-conscious. We saw a need to offer quality lighting systems without all the other [bells and whistles]." Medical Illuminations entered the surgical lighting market two years ago with its System One Orbital surgery light.

‘Bright’ lights
In recent years, surgical lighting systems have become "smarter" with touch-panel or remote controls, voice activation capabilities and even built-in self-diagnostic systems.

STERIS’ Harmony LA System features a control center with a universal power supply and a single, intuitive touch screen that unifies control over various visualization devices, such as lights, cameras and ambient lighting. With just one touch, surgical lights can be dimmed and camera color, orientation, zoom and focus can be adjusted. The system also ensures optimal performance by proactively checking and reporting on the lamp’s condition. This includes automatically correcting for voltage and lamp variations, preventing surgeons from having to adjust intensity mid-procedure.

Getinge introduced its new World Class Power Supply in July 2004, which uses software to track bulb life and maintenance schedules. "Rather than just relying on a back-up bulb, this will actually alert you when a bulb [is approaching] its end of life," said Rockow. "It will also tell you when the product was last serviced and when it is time for maintenance. It allows customers to be more proactive, which ultimately drives even more value."

Vendors agreed that surgical lighting systems will become even "smarter" in the future. Rockow predicted the introduction of wireless systems that will eliminate the need for cabling, as well as more advanced systems that can work in tandem with peripheral equipment to enable better data and image capturing of patient information.

Aside from that, compact lighting systems that pack more features into a smaller package will likely be on the horizon, along with digital video signals, high-definition cameras and enhanced computerized control centers.

Anderson said revolutionary light engines may also be developed with a "radically different design that is far more maneuverable, with significantly less potential for drift."

Enhancements to gas discharge technology may also be in store, he noted, adding that the current challenge with some gas discharge models is that the filaments are compromised when the surgical lightheads collide.

"A truly innovative light would remove filament type bulbs from the lighthead and would generate virtually no heat," he explained.

Regardless of the lighting technology in question, vendors agreed that customers can expect even more flexibility and value from their systems in the future.