I don't think it's possible to overstate the importance of surgical lighting or the importance of choosing the right lights for your OR. Whether you're outfitting a new OR or renovating an existing one, your selection of surgical lighting should consider the following factors.

Ceiling and clearance
Before you begin, you'll want to make sure you study up on the structure above the ceiling of the ORs where you're installing lights. Sturdy bracing is essential. The structural support not only keeps your lights securely mounted above the surgical site - I've seen poorly supported lights knocked off by collisions with other equipment - but it also lends stability in positioning the lights. Without good bracing, lights tend to drift from where you moved them.

The bracing should also protect your lights against damage or movement caused by vibrations from HVAC ducts or other infrastructural effects. Manufacturers should be able to tell you what support configurations are optimal for each lighting model. The height of the ceiling is another important architectural issue. Review the sizes and shapes of the lights you're considering in comparison to the dimensions of the room so that you'll know what kind of headroom remains for your surgeons and staff.

Given the increasing popularity of ceiling-mounted equipment booms and flat-panel monitors, you'll also want to review the placement of lights in conjunction with these devices - whether they're already installed or they're being added with the lights - to ensure that each can move freely and operate effectively without too much conflict. Most light and boom manufacturers now have the ability to offer potential customers computer generated, three-dimensional "walk-through" images of what their ORs will look like after installation and how the equipment articulates.

Trial and input
While it's possible to test lighting systems in exhibit halls and at the invitation of other facilities that have had them installed, there's no substitute for knowing how they'll work in your own ORs. If manufacturers can temporarily install the models you're considering in your surgical center - and many times, they can - there's no reason you can't trial the lights "at home" for a few weeks each.

Most surgeons will need only an hour or two under a new light to know whether they like it, but each of the surgeons who brings cases to your facility more than occasionally should be given the opportunity to try it and offer his input.

The perception and use of lighting is very subjective, and opinions on necessity and effectiveness will vary. An evaluation form that includes quantifiable factors, however, can help to keep the decision-making process fairly objective.

The surgical field
Nurses and scrub techs may be looking at hands-on features of surgical lights, such as the ease of maneuvering, changing a bulb or getting technical support, but surgeons' needs are quite a bit more aesthetic.

The quality and pattern size of the lighting are important distinctions, because surgeons are looking for lights that accurately illuminate colors and retain a consistent focus on the surgical site. They don't want to spend a lot of time asking for the light to be readjusted and refocused during a procedure. Consider also the amount of heat the lights generate. As surgical personnel draped in gowns and gloves under the OR lights for hours at a time will tell you, less heat is best.

The light itself shouldn't produce any shadows - and this is easily detected simply by turning the light on - but your staff should also determine what kind of shadows result from a member of the surgical team leaning or reaching into the field.

Are the lighting systems you're trialing able to supply indirect light to other locations during minimally invasive surgery's dimmed conditions? Some newer models have settings in which bulbs on the outside edge of the fixture provide soft lighting for anesthesiologists at their machines or nurses and surgical techs at the back table. As this can help them to better identify medications or instruments, indirect lighting can be valuable for patient safety.

Other options
The next wave of surgical lighting will involve LEDs (light-emitting diodes), small solid-state semiconductor devices that can be grouped to produce sufficient light. Manufacturers claim LEDs are brighter, cooler, longer lasting and more energy efficient than conventional bulb-type lighting.

Since LED lights are a relatively new technology in the medical field, some observers are still questioning how they'll age and whether they'll retain true color accuracy over the long term. This issue will doubtlessly be addressed and, if necessary, corrected in later generations of the technology due to the obvious benefits of LED lighting.

You may also want to consult with your surgeons on whether they have a need for lights that can be equipped with a digital camera. The overhead view can provide a more useful perspective than a view from the side for recordkeeping, off-site viewing or education. Even if it's not on your list of needs now, will your lights and OR data capabilities be able to accommodate the addition later?

The cost of light
Cost is, of course, a critical factor in the decision to purchase capital equipment, and you'll want to weigh the costs of each light you're considering against its features and benefits. But I don't think it's possible to say that cost is the most important, or even the second-most important, factor in the purchasing decision. This isn't equipment that you're going to replace every few years. You're looking for something that's going to last your facility for the long term, and lights are far too important to buy at a lower price if they compromise the needs of your surgeons and staff. Even though the need for light in the room has changed dramatically with the continuing trend from open to endoscopic surgery, remember that OR lights continue to be critical equipment in practically every case.

Berchtold Corporation
Chromophare D540 Surgical Light
(800) 243-5135
www.berchtoldusa.com
Price: $11,000
FYI: Berchtold's Chromophare D540 light is a bright, compact and easily maneuverable light for surgery center ORs, says the company. Offering a variety of configurations, from economical single lightheads to triple-mounted lightheads with flat panel monitors, it fits into almost any surgical space or equipment setup.

Burton Medical
Genie II
(800) 444-9909
www.burtonmedical.com
Price: $9,000
FYI: Burton Medical's Genie II surgical light provides illumination of up to 12,000 footcandles at one meter on an 8-inch to 10-inch spot for minimum eye fatigue, says the company. American-made and backed by a five-year warranty, the Genie II offers a durable, aesthetic arm system that is recognized for its drift-free, trouble-free operation.

DRE, Inc.
Vision Excel
(800) 477-2006
www.dremed.com
Price: not disclosed
FYI: DRE's Vision Excel surgical light includes a 16-inch (406mm) diameter elliptical reflector design for improved shadow reduction and an output of 6,000 footcandles at a distance of one meter, says the company. The Vision Excel has a large, pre-focused pattern with homogenous light distribution, a removable, sterilizable handle and an additional positioning handle on the perimeter. It can also be configured as a dual-head ceiling mount, a combo track mount or a portable floor model.

Maquet, a division of Getinge USA, Inc.
Maquet ALM X'Ten
(800) 475-9040
www.getingeusa.com
Price: $20,000 to $30,000
FYI: Maquet's ALM X'Ten surgical lights incorporate ten independent ports of light and a proprietary cross-shaped lighthead to eliminate shadows, says the company. Compact and easy to position, this illumination system employs patented LEDinside technology for ambient light applications. Micro-lens technology and dichroic-coated mirrors remove heat while delivering a true color rendition. ALM X'Ten lights are open channel, multimedia-ready and compatible with many integrated OR systems.

Nuvo, Inc.
Nuvo Surgical Light
(800) 663-1152
www.nuvosurgical.com
Price: not disclosed
FYI: Nuvo's surgical light allows power on and off, light intensity and pattern size to be adjusted from the sterile handle, says the company. A single 180-watt bulb provides 12,700 footcandles of illumination and a backup bulb starts within milliseconds if the primary bulb fails. Spare bulbs are conveniently stored in the light's wall-mounted control housing to eliminate long retrievals.

Skytron
Stellar ST2323
(800) 759-8766
www.skytron.us
Price: $11,000 to $33,000
FYI: Skytron's Stellar surgical lighting provides the ultimate in surgeon control, says the company, through a pair of surgical lightheads equipped with advanced, high-intensity focusable optics for up to 24,000 footcandles of soft white, shadow-free, cool illumination delivered without glare where it is needed most.

Steris Corporation
Harmony LC
Surgical Lighting System
(800) 548-4873
www.steris.com
Price: $10,635 for single light, $31,650 for dual lightheads and dual flat-panel monitors
FYI: Steris's Harmony LC system can be configured with up to three Harmony 500 lightheads with patented WaveLens technology and ordered with or without an in-light video camera, says the company. Up to four flat-panel monitors can also be added. The system includes a compact, flush-mounted control panel with camera control and LED indicators, says Steris.

Stryker Communications
Visum 600 Surgical Light
(877) 789-8106
www.stryker.com/communications
Price: not disclosed
FYI: The unique 600mm size of Stryker's Visum 600 light allows for easy maneuverability and high shadow resolution, says the company. With more than 12,600 footcandles of illumination, 4,200 degrees Kelvin color temperature and a 94-color rendering index, each lighthead produces brilliant, natural light, says Stryker. A high-intensity, low-wattage bulb and a high quality aluminum hood for optimum heat dissipation provides low-heat generation to the surgical field, adds Stryker.

Sunnex, Inc.
Celestial Star
(800) 445-7869
www.sunnexmedical.com
Price: $3,650 for dual ceiling-mounted (pictured)
FYI: Sunnex's state-of-the-art Celestial Star surgical lights meet the critical illumination, maneuverability and ease-of-use requirements that surgeons demand in the OR, says the company. Delivering up to 6,000 footcandles of White-RAL 9002 light in a space-saving design that features a 114-inch horizontal reach for head-to-toe coverage and a drift-free balance arm design, it is available in single and dual ceiling, wall and mobile configurations.

Trumpf Medical Systems, Inc.
Trumpf iLED
(888) 474-9359
www.us.trumpf-med.com
Price: not disclosed
FYI: Trumpf's iLED uses 184 white and color light emitting diodes to provide nearly 15,000 footcandles of low-heat, IR-free and virtually shadow-free illumination. The iLED gives the surgical team the ability to change color temperature for improved contrast and tissue differentiation. Plus, LED technology reduces operating costs and bulb replacement frequency due to a service life of 20,000 to 50,000 hours (five to eight years).

VisiLED Corporation
Halo OR Operating Room Light
(607) 755-5400
www.visiled.com
Price: not disclosed
FYI: VisiLED's Halo OR overhead light uses light-emitting diodes (LEDs) to bring the future of illumination to medicine, says the company. The lighting system, which is expected to receive FDA approval in the first quarter of 2007, is more energy efficient, longer lasting and brighter than conventional systems. The Halo OR is shadowless with no-heat illumination and true color and its light weight eliminates drifting when positioning.