Just as certain types of microscopes have been developed with ophthalmic or ENT surgeries primarily in mind, spinal microscopes are optimized for such procedures as laminectomies, fusions, artificial disc placements and decompressions.

Our 10-OR hospital has four spine scopes, which meets our facility's needs and our surgeons' demands. On any given day, three of them are in nearly continuous use. While the field of manufacturers offering spine microscopes is a comparatively narrow one, there are still several important factors to consider if you're looking to equip or upgrade your ORs for spinal procedures.

Scope specifics
Three main features distinguish spine scopes from other OR scopes:

• Longer focal distance. A spine surgeon works standing up, so his eyes - and the scope's eyepiece and optics - are further from the operative site, as compared to ophthalmic surgeons, who are often seated with a view close to the patient's eye. In addition, spine scopes may need to allow space for larger instruments or surgical maneuvers. As a result, while the distance from the bottom of the objective lens to the surgical site on many eye scopes is about 175mm to 200mm, spine scopes generally have a focal distance of 350mm to 500mm.
• Dual stereo optics. Many other scopes' assistant eyepieces are facilitated by reflective beam splitters, which offer binocular vision but not true stereo images. Given the larger role frequently played by spine surgeons' assistants and their need for image depth, a spine scope's assistant eyepiece (positioned head-to-head across the table from the surgeon's) provides the same three-dimensional vision that the surgeon has.
• More light. Since spinal surgery, unlike eye surgery, often takes place in deep cavities, stronger illumination is required. Spine scopes usually employ high-powered xenon light sources instead of the halogen bulbs used by many eye scopes.

Trial and input
After discussing your facility's needs with your surgeons and identifying the equipment that's available, it's time to trial your scope possibilities. Arrange for each vendor to supply its scope at your facility for two or three weeks.

We have block scheduling, so we know when each surgeon will be here, and we let them know we have the new equipment we want them to try.

You'll want feedback from as many trials as possible, so if one surgeon isn't able to attend during the trialing period, ask the vendor if it's possible to bring the scope back. If it's applicable, include surgeons from other specialties to try out the scope. The spine scopes we've chosen recently are versatile enough that our plastic surgeons use them, too.

Opinions will vary, but surgeons will be judging the equipment on its ease of use, its optics and field of vision, how smoothly it repositions and perhaps its ability to expand with hardware such as cameras, recording devices or image-guided systems.

In addition, don't neglect the surgical staffs' views. They can offer valuable insights into how quickly they learned to operate the scope, how convenient it was to use and whether it was difficult to move.

More of the same?
When equipment is the issue, surgeons tend to gravitate toward the types or manufacturers that they're most familiar with. If you've already purchased one or more spine scopes, it may be in your interest to consider buying your next one from the same manufacturer.

The uniformity of scopes at our facility offers a few advantages. First, if one should fail and need repairs, parts from any of the other three - a bulb, a lens, an eyepiece - can be temporarily exchanged into it.

Second, standardizing scopes means that the applications on each are the same, making it easier for staff to operate each when they move from room to room and procedure to procedure. Likewise, each scope will be adaptable to the peripherals in each room.

Lastly, it solves a big scheduling problem by preventing surgeons who have a preference for one piece of equipment from getting stuck with another of a different make that they don't like quite as much.

Seeking out support
With equipment as complex and as vital as an OR microscope, you'll want to ensure that the vendor's service contract offers continuing support, not just a one-time education for the staff when the scope first arrives at your facility. Return visits for refresher or in-service courses might prove valuable, especially if you hire new staff.

In addition to regular repairs and maintenance, such visits might also show the way toward enhancing the equipment you have. Sometimes the vendor's rep can point out features that were included in the scope that your surgeons haven't been using - perhaps because they've forgotten they're there - or explain how the equipment you have can be upgraded to accomplish the tasks they now want it to do.

If you have a long-standing order with a vendor, it's easy to determine the quality of service that will follow your purchase, but if you're considering a new and different vendor, it will be worth your while to contact other users in your area to ask them for their views.

Fitting in
While OR microscopes are becoming more compact in size to accommodate surgery center use, they still occupy a fair amount of space in ORs increasingly cluttered with technology. Spine scopes in particular have longer optic arms in order to reach the spine at the center of the body and the center of the OR table.

As you're trialing scopes on site at your facility, be sure to note their dimensions in comparison with the rooms they'll be used in as well as with the surgeons, staff, C-arms and other equipment they'll be competing for space with.

It's also advisable before purchasing a scope to consider where you're going to store it. The optic arms do fold up, but you'll have to make sure it's out of the way; or, if it does end up in the hallway, that staff and stretcher traffic flow doesn't do it any damage. Similarly, keep in mind how easy and efficient it is to move it from where it's stored to where it's needed.

Cost: the bottom line
The differences that distinguish spine microscopes from other types of OR scopes, as mentioned above, tend to also make them more expensive in comparison. Expect to pay $100,000 to $200,000, depending on the options and enhancements included in the scope.

It's a significant capital investment and cost will factor into your choice, of course. But sometimes you have to bite the bullet when you realize that the most expensive scope you're considering has everything you and your surgeons need. That's where your materials management experts play a big role. Explain the situation to them and see what they can negotiate with the vendor or with the benefit of a buyers' group or purchasing contract.

You might also consider refurbished scopes. If a vendor's selling lightly used demonstration equipment for sale, it might offer you substantial savings over a brand new scope. Trialing is especially important here, as you want to make sure it works properly from the start. Plus, you'll want to make sure it's covered by a full warranty for repairs in the event it stops working so well. But don't compromise on its applications. With a purchase this big, you don't want to buy for economy's sake if it's not exactly what you're looking for.

Spine Microscope Manufacturers

Leica Microsystems, Inc.
Leica M520 F40
(800) 526-0355
www.leica-microsystems.com
Price: $80,000 to $110,000
FYI: The M520 F40 features the same premium-class optics and 300W xenon illumination found on Leica's high-end surgical microscopes, plus a more compact footstand suitable for outpatient surgery settings, says the company. The MultiFoc variable lens offers focal distances from 207mm to 470mm, making it easily adaptable for multiple specialties, including spine, ENT, plastic, reconstructive and hand.

Carl Zeiss Surgical, Inc.
OPMI Vario S 88
(800) 442-4020
www.zeiss.com/surgical
Price: $60,000 to $90,000
FYI: Zeiss's OPMI Vario S 88 scope is a multidisciplinary system offering brilliant optics and illumination, as well as ease of use and maneuverability, says the company, and is available on a floor stand with a rigid or lifting column or as a ceiling-mounted device. Features such as high-speed, apochromatically corrected Varioscope and zoom optics, a focusing range of 200mm to 415mm without the need to change the objective lens and integrated adjustable xenon illumination, all in a flexible, compact design, allows comfortable work even in extreme positions, adds Carl Zeiss.

Spine Microscope Refurbishers

Endure Medical, Inc.
(800) 736-3873
www.enduremed.com
Price: $25,000 to $80,000
FYI: Endure Medical sells new and refurbished surgical microscopes and accessories for every specialty and budget, says the company. Its spine microscope inventory includes Leica, Zeiss and Moeller. All systems are returned to like-new condition and are backed by a full two-year warranty that includes parts and labor. Complete installation and in-service accompany every microscope purchase.

Prescott's, Inc.
(800) 438-3937
www.surgicalmicroscopes.com
Price: About 50 percent less than new equipment, says the company.
FYI: Prescott's, Inc., is dedicated to the sale and service of reconditioned surgical microscopes from such brands as Zeiss, Leica, Moeller, Global, Topcon and Weck, says the company, and offers equipment for any budget. Prescott's also offers a complete service program supported by highly trained field technicians located nationwide.