We recently conducted a headlamp trial at our physician-owned hospital, inviting the manufacturers of 7 battery headlamps and 7 xenon fiber-optic sources to display their products for a day. After a brief presentation by the vendors, all the products were available for surgeon and staff comparison. We selected 5 battery headlamps to be trialed extensively in the OR for 10 to 15 hours each. We focused on the following 4 features:

1. The benefits of being untethered.
Newer, solid-state headlight options like light-emitting diodes (LEDs) and high intensity xenon arc discharge (HID) lamps are powered by battery packs worn on the surgeon's belt. LED or HID headlights add no cables to your already cluttered OR floors and let the surgeon roam freely about the OR without having to unplug from and plug back into the light box. Unlike xenon lamps, LEDs and HID lamps run at 100% output for tens of thousands of hours (translation: many years) before they begin to degrade, so what you get right out of the box and what you get 5 years later is the same quality of light.

2. The true cost of ownership.
Conduct a 5-year cost-of-ownership comparison to get an accurate picture of the long-term costs of different headlights. Here's what we learned when we compared xenon fiber-optic to battery-powered headlamps.

• At about $6,000 to $8,000, the one-time purchase price for a tethered xenon light source, including the light box and headset, is comparable to the purchase price for the very best and most expensive battery-powered headlamps with light output comparable to a 300-watt xenon light box.
• Other excellent battery headlamps cost between $2,000 and $4,000. The daylight-equivalent quality of these lights exceeds that of a xenon light box, but the luminescence doesn't compare to a 300-watt xenon source and may not be suitable for deep cavity work.
• Xenon bulbs are often rated for 500 to 1,000 hours of use. Replacement costs range from $600 to $900 yearly or every other year depending on usage.
• Coaxial fiber-optic cables treated with care need replacement after about 30% of the cables are broken. Expect to replace cables every 18 to 24 months in a busy OR. A 7-foot to 10-foot cable replacement runs $400 to $900.
• LED and HID headlamps are rated for 10,000 or more hours with consistent light output for at least 5 years. You'll need 2 batteries for each user (one battery charging while the other's in use) for uninterrupted run time. Replace batters yearly. Batteries are rated for 300 to 500 charge cycles, with replacement costs of a few hundred dollars for LEDs and considerably more for HID models.

3. The quality of the light.
Surgeons should evaluate 3 qualities of the headlamp's light:

• Luminescence. Does the battery headlamp provide the needed tissue illumination? The illumination needs of a plastic, hand or oral surgeon differ from those of a spine surgeon operating in a deep cavity.
• Spot fill. Does the light fill the surgeon's field of view? This differs if the surgeon is wearing loupes and if these are expanded-field loupes. Typically, expanded-field loupes allow a field of view of 2.5 inches at an 18-inch focal length with a 3.5X magnification. Ensure that the light spot fills this field and doesn't "fringe" at the periphery.
• Light temperature. Does the light give off a blue or yellow hue? Ideally, the light should mimic the height of daylight, giving the most "natural" illumination to tissues and vessels (5,500 to 6,400 Kelvin).

4. Wearability.
Headlamps and surgical telescope loupes are worn for hours at a time. At first they may feel very light, but fatigue and neck strain can still occur. Some of the devices I trialed were bulky, poorly balanced and interfered with my surgical loupes, which was really irritating. With some models, I'd bump into my assistant surgeon with the headlamp. It's imperative that you trial surgical headlamps with your surgical loupes. Trialing the device in the exhibit hall is no substitute for trialing it for 5 to 6 hours in the OR. In addition to the comfort of the lamp on your head, take note of the battery pack. Be aware that getting a solid-state headlight system that's as bright as your old tethered xenon system may mean wearing heavier battery packs. Some of the devices have batteries the size and weight of a smartphone that just clip onto your scrubs. For some of the best devices, however, the battery pack weighs 2 pounds and requires wearing a special belt and harness.

There are tradeoffs to shedding those fiber-optic cables, but I'm convinced this is the future of surgical illumination. For me, it's also the present. I switched to my battery LED headlamp a year ago and have no intention of changing back to a tethered source.