You should strongly consider your surgeons' preferences in auxiliary lighting equipment when buying headlamps. The influence of what they're used to and even what they first trained with can be strong, especially when it comes to a device with which they're working so closely. I tend to bring my own headlight with me when I perform surgeries in different facilities, simply because I'm used to its light quality, positioning ability and fit. It's details like those that'll make or break a surgeon's day and prove the value of your purchase.

Headlight types
Every surgical headlight uses one of three lighting systems: halogen bulbs, xenon bulbs and light-emitting diode, more commonly known as LED, technology.

For decades, halogen bulb lighting was the standard for headlight devices. Since most halogen systems are designed to operate without external light sources, the battery-powered and cordless devices allow the surgeon illumination with total mobility.

As you'd expect, light quality is a critical factor in a surgical headlight's usefulness. Light quality can be judged by its intensity or brightness - as measured in foot-candles or lux, with higher numbers meaning brighter illumination - as well as by "color temperature," or the accuracy with which the light illuminates the true color of the subject. Color temperature is measured in degrees Kelvin (K), which represents the particular hue of the light. Higher numbers here equal whiter light, which can make subtle differences in identifying and differentiating anatomical features based on appearance.

While halogen bulbs provide strong intensity, their color temperature is generally around 3,000 K, which means their light tends to be tinted slightly yellow. On this front, xenon lighting offers an improvement.

Xenon headlights emerged in the late 1990s with color temperatures of about 6,000 K, giving them a whiter or bluish-white light. The bulbs themselves also run cooler than halogen bulbs, increasing their appeal to surgical headlight users. The whiteness and coolness come with a trade-off, however: xenon headlights require an external power source and fiber optic cables to connect the lamp to the source of its illumination, slightly limiting mobility. While xenon lights tend to be more expensive than their halogen counterparts, their prices have become more competitive and less out-of-reach for many smaller surgical facilities.

In recent years, some manufacturers have begun offering LED headlights. The lights, which illuminate through solid-state semiconductors instead of filaments, are said to provide brightness and color temperature as high as or higher than xenon and fiber optic-powered headlights, but without a cord and with virtually no maintenance required over time, providing the advantages of both systems.

Cord or cordless?
Being untethered by a fiber optic cable has its pluses, but untethered illumination - at least in terms of halogen lights - might not be the optimal choice in the OR at this point. I've found that cordless models provide a little less light intensity than I require in the OR. I don't need that much intensity in my office exam room, however, so cordless headlights are an ideal (and less expensive) choice there.

Since you don't want to lose your light in the middle of an exam or a procedure, you'll also want to make sure that the rechargeable battery powering your light can last a day in the clinic or surgery or, if it can only handle half a day, that you have a spare battery close at hand when you're using it.

The fiber optic cables that transmit light from the source to the headlamp in a xenon system have slimmed down with advancing technology. While they used to be about one centimeter in diameter, they've since been narrowed to less than half that in some models. The smaller size and lighter weight makes a difference in mobility, especially when you're talking about six feet or more of cord. But it's also possible then that a surgeon may forget he's tethered, step an inch too far and see the cable pull the light out of its position on his head or turn out the light by unplugging itself. The circulating nurse on a case might have to keep an eye on the cord, or if you've got a very mobile surgeon the headlight may have to be unplugged and replugged as he moves around.

The light source that the fiber optic cable plugs into can generate noise and heat, so the surgeon will definitely want to put some distance between himself and the machine on a stand or cart. Facilities with active endoscopy programs may already have light sources unit for their scopes. If this is the case at your facility, make sure that the headlights you're considering can plug into it. Otherwise, consider purchasing a light source with a turret that accommodates multiple fiber optic cables for headlights and other applications.

Point and fit
Stable positioning is a key component in choosing a surgical headlight. After all, if you're going to use a light that shines exactly where you're looking, you'll want it to stay in the right place.

A headlight's positioning can be determined through its articulation - is it easy to move and sensitive enough to point exactly where you want it? - and holding power - once you've aimed it, is it fixed to that position, or is it too loose to stay firm? Constantly repositioning a light is not only annoying, but can pose sterility issues since you'll potentially contaminate your gloved fingers with all the fiddling. Sure, you can use pieces of four-by-four gauze to shield your fingers from the adjusting knob or joystick, but it would be easier if the light just stayed in place.

Steady positioning also depends on keeping the light from shifting as you wear it. For that, you'll need a comfortably fitting headlight. A rigid crown with a solidly attached light and adequate padding that fits snugly on a surgeon's head should do the trick.

Of course, comfort has a greater benefit than just assisting in positioning. As with comfortable shoes, a quality headlight is essential for surviving long surgeries without undue fatigue. Most headlights are constructed from lightweight materials to minimize neck and back pain during extended wear. Some also incorporate small fans to cool the wearer against the warmth of bulbs or long procedures. To judge these ergonomic qualities, a trial period is always helpful.

Necessary repairs
A high-quality surgical headlight unit should last you many years. Still, halogen and xenon bulbs have an estimated life of two to five years and the fiber optic threads in light source cables can break over time and degrade the quality of light transmitted, particularly in narrower cables.

Preventative care, such as dimming the intensity of a light until brightness is needed instead of repeatedly switching it on and off (which wears down the bulb) or not coiling fiber optic cables too tightly, can extend the life of these components. But eventual repair or replacement of equipment is inevitable.

Research the warranty and the potential cost of its maintenance, and ascertain the details of obtaining service. For smaller repairs, such as a burned-out bulb or a failed fuse, keep spares for each model you own on hand. While the manufacturer will be able to supply such parts as long as it supports those models, your materials managers, armed with model numbers, may be able to locate the same components at lower prices through third-party distributors.

Applied Fiberoptics
Gemini Headlight
(800) 874-8358
www.appliedfiberoptics.com
Price: not disclosed
FYI: Lightweight at only 6 ounces and ergonomically balanced, Applied Fiberoptics' Gemini incorporates superior optics in a durable, ultra-low profile headlight, says the company. Illuminating brilliantly while letting surgeons work closely without headlight interference, the encapsulated design also doesn't interfere with surgical loupes. A convenient side-access joystick allows easy adjustment and a spot control range of 10mm to 80mm.

BFW, Inc.
Maxenon Xi 300
Fiber Optic Headlight System
(800) 717-4673
www.bfwinc.com
Price: $5,900
FYI: BFW's Maxenon Xi 300 system is so bright, says the company, that many surgeons turn it down, confident in the knowledge that they can dial up the intensity when it's needed. Benchmark features such as Hot Start and a technologically advanced cooling system are engineered to prevent failed startups and overheating. The result is dependable, extreme white xenon light through even the longest cases, says BFW.

Burton Medical Products
XenaLux
(800) 444-9909
www.burtonmedical.com
Price: $6,000 for complete system
FYI: Powered by a 300-watt xenon source, Burton's Xenalux OR headlamp system offers an intensity of more than 120,000 lux (11,148 foot-candles) on a variable spot with a circular beam, says the company. A lightweight, sweat-absorbent headlamp adds reliability and comfort. The Xenalux Illuminator light source includes a rotary turret for Wolf, Storz, Olympus, ACMI and Pilling connectors.

Enova Medical Technologies
Halo Cordless LED Surgical Headlight
(866) 773-0539
www.enovamedical.com
Price: $2,500 for Halo 5000, $3,500 for Halo 6000
FYI: The Halo Cordless LED Surgical Headlight offers unparalleled brightness with very little maintenance required, says the company. The Halo's patented technology delivers OR-quality light output in a portable, battery-operated system and is ideal for the surgical suite or routine office use. The Halo is available in two models, the Halo 5000 at 55,000 lux (5,110 foot-candles) and the Halo 6000 at 65,000 lux (6,039 foot-candles).

Heine North America
3S LED Headlight
(800) 367-4872
www.heine.com
Price: $958
FYI: The ultra-bright and compact 3S LED Headlight from Heine provides powerful coaxial illumination and weighs only 2.5 ounces, says the company. In terms of illumination, the 3S LED features a light output of 30,000 lux (2,787 foot-candles) and a reference color temperature of 6,000 degrees Kelvin, and for comfort and convenience includes the professional headband with plug-in transformer and headband-mounted brightness control.

IsoLux, LLC
Medical Illuminators and Surgical Headlights
(978) 774-9136
www.isoluxllc.com
Price: not disclosed
FYI: IsoLux, LLC, uses Luxtel's core technology to produce medical illuminators harnessing xenon's 6,000 degrees Kelvin daylight for true color rendition, says the company. IsoLux's headlamps offer 100 to 300 watts of illumination with a compact rotating turret, bifurcated cables with universal terminations and an optional video camera mounted on the headlamp.

Luxtec Corp.
UltraLite Plus Headlight System
(800) 325-8966
www.luxtec.com
Price: $1,300
FYI: With more than 50,000 units sold worldwide, the Luxtec UltraLite Plus is among the lightest and brightest surgical headlight available on the market, says the company. Its lightweight, ergonomic design and superior optics afford surgeons exceptional comfort and visualization throughout their longest cases. Luxtec notes that its trademarked SIL-KORE tubing enhances the overall lightness as well as keeping the fiber optic cable easily visible.

Products For Medicine
White Sun Surgical Headlight System
(800) 333-3087
www.productsformedicine.com
Price: not disclosed
FYI: Large and bulky surgical headlights restrict a surgeon's view and prove unwieldy during long and involved procedures. Products For Medicine's White Sun Surgical Headlight System is designed for the surgeon who needs power and accurate illumination without the weight, says the company. It's manufactured with aluminum alloy for maximum durability and light weight, and no modifications are necessary for it to be used with optical loupes.

Steris Corporation
Fiber Optic Headlight
(800) 548-4873
www.steris.com
Price: not disclosed
FYI: Steris's Fiber Optic Headlight is engineered for superior comfort and performance, says the company. The headlight's xenon light source and precision-designed three-lens system provide high quality, dependable illumination and a large, bright spot. The headlight also offers an ergonomic design for comfort through its lightweight optics, heat-resistant materials and a form-fitting headband with less cable on the band.

VisiLED Corporation
Halo-XT Surgical Headlight
(607) 755-5400
www.visiled.com
Price: $3,750
FYI: The VisiLED Halo-XT Surgical Headlight is an untethered, lightweight and super-bright headlight that offers the surgeon freedom, says the company. Light-emitting diodes (LEDs) eliminate the need for expensive external light sources. The self-contained, battery-operated Halo-XT will retain its brightness for more than 20,000 hours.

Welch Allyn, Inc.
CL Series Surgical Headlight Systems
(866) 801-8428
www.welchallyn.com
Price: $3,995 to $6,295
FYI: CL Series light sources power both small-diameter single-fiber and traditional multi-fiber fiber optic cables. They provide an average of more than 1,000 hours of lamp life. With its reduced spot size, the Microlink SFI (single-fiber illumination) provides increased brightness.