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Cool Surgical Lights
Not only are shadows and bulb replacement absent with the new LEDs, so is heat. Here's what you need to know about lighting's latest.
Nathan Hall
Publish Date: October 10, 2007

Coming soon to an OR near you: Futuristic-looking surgical lights that bathe the surgical field in bright, shadow-free, color-correct light that's both cool to the touch and easy on the eyes. Lights that let your surgeons control the focus and select the color temperature. Lights that are kind to your electric bill and bulbs that need replacing once a decade.

Yes, it's easy to see why LEDs are such a hot topic in surgical lighting. As more and more companies gain FDA approval for their light-emitting diode systems and the buzz surrounding these honeycomb-shaped lights grows, here's what you need to know so you can decide what to do when your halogen lights need replacing.

Getting the LED out
LEDs are tiny light bulbs that fit into an electric circuit. Instead of using a filament as regular bulbs do, LEDs produce light through a simple semiconductor, or diode, plugged into a circuit board. The diode is made from highly conductive material so it only takes a small amount of electricity to create a bright but low-heat light that is focused into a beam by a transparent plastic case. Let's examine a few of the system's key features.

Cool light. Even directly under the lamp, you'll feel practically no heat, a feature that's sure to improve the comfort and productivity of the surgeon and the surgical team.

"The huge clinical benefit is high intensity with a fraction of the heat, if any, typically produced by halogen systems producing similar intensities," says Randy Tomaszewski, vice president of marketing at Skytron, which last month received FDA 510(k) clearance for its Aurora LED surgical lights that let surgeons choose between bright white (4,500K) or soft white (4,000K) color control. "Obviously a light that gives off more heat can have a negative impact on surgical team comfort and performance, particularly in longer procedures," says Trumpf Medical Systems spokesman Dave Rector.

"There's not much heat coming off these lights, so the physicians will still feel cool when they're under them, which means they'll sweat less and be able to get more done," says Travis Darwin, corporate materials manager at the Dallas-based healthcare development and management company Cirrus Health. "LED systems cost a little more, but they're worth it. And for us, it's about staying on the cutting edge."

It isn't just the medical team that can benefit from reduced heat, says Sushil Gupta, MD, founder of VisiLED, which is seeking FDA 510(k) approval for its VisiLED Halo-OR system. Lights that are hot enough to dry the patient's tissues could also be a safety concern, he says.

Shadow-free light. LED lights even compensate for the shadows that are cast over the surgical site by the position and movement of the surgical team, as well as by equipment. Because each LED has its own convergence lens, each also generates its own light field. Together, the fields combine into a shadow-free light. Performing surgery is hard enough without your surgeons having to worry about getting enough light or struggling to get a lamp into the right spot. Compared to all the lights he's worked with in more than 20 different facilities, Jon E. Orjala, DO, an orthopedic surgeon and partner at Bailey Medical Center in Owasso, Okla., says his LED system is both easy to use and easy on the eyes. "There are no shadows and I can adjust the light to be wide or focused into a spot by using sterile controls that can also change the light's intensity," says Dr. Orjala. "I can pull it close and not have to worry about shadows or heat."

After Deciding What Kind Of Bulb You Want...

Picking the technology may be the biggest decision you have to make when selecting surgical lights, but there are still many little factors that can affect how effective your lighting system is at the clinical level. These include:

' Drift. "The lighter a light is, the less likely it is to drift," says Daniel Herron, MD, chief of the Bariatric Surgery Section at Mount Sinai Medical Center in New York City.

' Shadows. "You want to have some shadows because they give you depth perception when you're operating, but you don't want half of the site in darkness and other half in light," says Dr. Herron. "Ultimately, you want something that gives uniform light throughout."

' Brightness. "The abilities to adjust brightness and focus are musts," says Patrick Price, RN, ADN, BSN, surgery supervisor at Integris-Baptist Regional Health Center in Miami, Okla.

' Heat. "You can determine that after a couple of minutes," says Dr. Herron. "If you turn it on and it gets warm underneath, you can tell you'll be sweating under the light."

' Manufacturer. "The company making the light should not only have a reputation for quality but also for service," says Mr. Price.

' Color. Some LED systems offer a color rendition feature to help surgeons differentiate delicate tissues, says Jon E. Orjala, DO, an orthopedic surgeon and partner at Bailey Medical Center in Owasso, Okla.

- Nathan Hall

Long life cycles and less energy. LEDs have dramatically long life cycles - about 20,000 hours, or as long as 10 years, and even then will have retained 90 percent of their original light intensity, says Mr. Tomaszewski. LEDs use one-third the energy required to power traditional halogen lighting systems. They also minimize the cost, time and surgical interruptions related to changing more expensive halogen or gas discharge bulbs commonly used in today's surgical lights. Typical halogen bulbs for single-bulb driven systems last up to 1,000 hours, says Mr. Tomaszewski.

"When you're in surgery and the light bulb goes, it could be problematic," says Dr. Gupta. "I've had bulbs blow out in middle of operations."

Some LED systems also have backup circuit boards as a secondary power source if the first fails, says Pam Rockow, senior product marketing manager for Maquet Surgical Workplaces, a subsidiary of Getinge USA. "Unless you lose all power to the facility, you'll always have light," she says.

For all the benefits, LED systems are 10 to 20 percent more expensive than halogen lighting. Skytron says its Aurora, for example, is priced 17 percent higher than present systems.

Too new to trust?
While some are excited about LED technology, others, such as Victor Donahue, director of product management for equipment planner HELP International in Dallas, still have some reservations about the technology. He advises against paying extra for a system unless you're getting a definite benefit.

"Most LED systems have the same candlepower as older OR lights," he says. "You're going to pay more, so what advantage are you getting? They may not radiate as much heat, but they'll still emit some. They also talk about color rendition, but as far as I know there are no white papers suggesting LED is more clinically appropriate than a regular light."

Despite the lack of clinical experience with these systems, Mr. Donahue says some people will still purchase LED lights simply because they're new. "With any new technology, you have the early adopters, that five percent or so who want the latest and greatest regardless," he says.

To Mr. Darwin, there is already proof that these lights work well in ORs. "These lights were proven effective for a year in Europe before they were introduced here," he says. "The track record is there."

Manufacturers are also working to troubleshoot any potential problems in their products, says Ms. Rockow. Her company is actively trialing the Maquet PowerLED Major Surgical Lighting System in facilities to ensure as few problems as possible when it's released later this year. "Our customers are really happy with the results so far," she says.

Other light choices
LED is getting a huge boost thanks to its presence in consumer products, in the same way high-definition televisions drove customer acceptance of HD imaging, says Alan Campbell, product manager for surgical lights at Berchtold USA in Charleston, S.C. He says it's important to remember that there is another advanced technology for surgical lights, specifically High Intensity Discharge (HID), or Xenon, which also offers cool, bright and shadow-free light.

"HID is not going to have that kind of pop-culture awareness because it's a specialized technology for high-powered applications," says Mr. Campbell. "For higher-output applications, it's a very efficient light source, but unless you know about headlights or floodlights you're not going to know about HID."

Instead of developing an LED system, Mr. Campbell says Berchtold has just started marketing a second-generation HID system, the Chromophare X66. This system will list at $27,000 for a single configuration or $45,000 for a double configuration, comparable to most LED systems currently on the market.

Mr. Campbell says the current generation of HID bulbs last about 5,000 hours, still a significant improvement from the halogen bulbs that only last about 1,000 hours and have to be replaced about every six months.

"Is there a big difference if someone changes bulbs every five years or every eight to 10 years?" says Mr. Campbell. "It's an issue when it has to be done every five or six months on a regular basis because that can interrupt the flow of the OR. But if it's longer than that, it's not much of a problem."

Even with LEDs on the market, Ms. Rockow says halogen lights will still have a place. "There are many customers who are happy with what they have and they don't want the new technology," she says. "Or they may want to keep their ORs constant from a safety perspective by using all of the same systems, and they can't upgrade everything at once."

What's bright and right for you?
If the competition is close between two technologies, Ms. Rockow suggests doing a side-by-side comparison of the two systems. This way, you can see not only how each light looks in your OR but also how easy they are to move and position.

Another way to assess the real world value of a system is to find a facility in your area that is using those lights and pay them a visit, says Patrick Price, RN, ADN, BSN, surgery supervisor at Integris-Baptist Regional Health Center in Miami, Okla. "Check the lights out when they're being used, and talk to the staff to find out what they think about them," he says.