In such surgical specialties as ENT, general abdominal and neurosurgery, the value of a surgical headlight is clear. An overhead OR light is not particularly effective at illuminating the small-cavity surgical sites these specialties work with. Auxiliary lighting, however, brings focused brightness to the task, and surgical headlights free up the user's hands. Here's how to decide which one works for your surgeons.

Light quality
As with any precision lighting instrument, surgical headlight illumination is judged by intensity and color temperature.

Intensity, or brightness, is measured in foot-candles or lux (with 1 foot-candle equaling about 10 lux). A higher number represents a brighter light. Color temperature describes the accuracy with which light illuminates the true color of the subject illuminated. Measured in degrees Kelvin (K), color temperature numbers that are higher represent whiter light.

The light that surgical headlights provide originates from one of three sources: halogen bulbs, xenon bulbs or light-emitting diode technology.

Halogen bulbs have long been a standard in surgical lighting, generating light with strong intensity and a color temperature that ranges around 3,000 ?K, which lighting experts say provides a slight yellow tint.

The introduction of xenon bulbs in the 1990s brought intense light that ran cooler than halogen and had a color temperature of about 6,000 ?K, which is said to be tinted slightly blue.

As a casual, but clinical, observer who has worked with both halogen and xenon headlights in different surgical environments, I find them both bright enough for the surgeries I perform. When the subject is one-and-a-half to two feet away, I find it difficult to tell the difference between their illumination.

The most recent advance in light sources is light-emitting diode, or LED, technology. Seen in OR overheads and traffic control devices, among other lights, in recent years, LEDs use solid-state semiconductors instead of filaments to generate light more intense than xenon bulbs with little heat and a color temperature that can reach 10,000 ?K.

The right fit
Your surgeons will want headlights with beams that are bright, but not too hot. Some headlight models feature small fans intended to cool the unit or crowns designed for efficient ventilation.

Since surgical headlight users may well be wearing them for an hour or more at a time, a comfortable fit is essential to surviving long surgeries without fatigue. To find the best fit, users will have to physically trial the options that are available, so make sure you arrange with manufacturers to obtain loaner products for your surgeons to test drive.

Some headlights are mounted on lightweight, adjustable plastic crowns, others on more flexible bands secured by Velcro. The plastic headsets offer more form, but you'll want to make sure they're sufficiently padded for comfort during extended use. The pliable, Velcro-bound headbands are comfortable, but I've found that the light sometimes moves when you do. Stable positioning is key to effective headlight illumination, so you'll want something that you can set once and forget about, instead of having to repeatedly ask the nurse to reposition or reach for a sterile towel to do it yourself.

Many headlights let the user adjust the size of the beam, from a pinpoint- to a pancake-sized spot of light. I'm usually working with a half-dollar-sized spot. Different lights situate the beam source at different places on the user's forehead or brow. While the bulb isn't always directly in line with the user's eyes' line of sight, the surgical field he's working with is usually a small one, and he's not looking around corners.

External connections
Fiber optic cables run from the surgical headlight over the user's head and out the back of his gown to plug into the light source unit, which powers the light. With six feet or more of available cable, mobility is maintained. The cord can be clipped to the user's gown or scrubs, although this configuration can make him feel more tethered.

The light source is generally a shoebox-sized unit on a wheeled stand or cart near the OR table for convenience. It's similar in nature to the light sources that endoscopy facilities use to power their scopes, and most surgical headlights could plug into that hardware if their own source units failed.

The headlight's light source won't take up much space in equipment-cluttered ORs, but logistics will be a concern. There can't be a great distance between the user, who may have to move around, and the unit, which the headlight's cord has to reach. The light has to remain on the user's side of the table, since placement elsewhere courts a kinked neck, and stepping too far may unplug the light or jostle its position on the brow.

Some headlights are powered by a built-in battery. In that case, the cord runs down the user's back, where the battery pack is clipped to his waist. Mobility is assured, although battery-powered lights also require assurances that their rechargeable units can last a day of surgery, or can be replaced with spares.

Cost considerations
Lastly, just because they're smaller, simpler devices than some of the other capital equipment in regular use in your ORs doesn't mean that surgical headlights are free of future costs. Repairing or replacing headlight components is always possible in the long term, since bulbs burn out and fiber optic cords break down over time. When reviewing your product choices, remember to budget in the potential cost of maintenance as well as any accompanying warranty and the manufacturer's availability and reputation for servicing its products.

Applied Fiberoptics
Gemini Headlight
(800) 874-8358
www.appliedfiberoptics.com
List price: $1,295
FYI: The Gemini's optics are mounted in a low-profile headlight that provides brilliant, stable illumination while preventing the annoying "rams effect," the headlight interference that can occur when two or more surgeons work closely over a surgical site, says the company. The fully adjustable, six-ounce headlight is designed to sit low on the brow to direct the variable 10mm to 80mm spot along the line of vision without interfering with loupes or goggles.

BFW
Maxenon Xi 300
(800) 717-4673
www.bfwinc.com
List price: $6,100 for Maxenon FOS 4X surgical headlight system, which includes Maxenon Xi 300, High Beam Tri Lens headlight and mobile stand
FYI: Maxenon's Xi300 delivers dependable white xenon light with the help of a hot start function to avoid failed startups and a fan to prevent overheating. The High-Beam TriLens fiber optic headlight can project an 11.5cm spot at 40cm and is mounted on a crown of lightweight, heat resistant DuPont Minlon for user comfort.

Enova Medical Technologies
Iris Surgical Headlights
(866) 773-0539
www.enovamedical.com
List price: Solo 50, $795; Solo 100, $1,295; Duo 100 (pictured), $1,495;
Duo 200, $1,995
FYI: Enova, the manufacturer of the Iris Duo 100 (its 100,000 lux cordless LED surgical headlight), is scheduled to add the Iris Solo 50 (50,000 lux), Solo 100 (100,000 lux) and Duo 200 (200,000 lux) models to its product line in September. A redesigned, self-contained battery pack recharges in less than three hours and provides four to eight hours of power, depending on the intensity setting, says the company.

Integra Surgical
UltraLite Headlight
(800) 325-8966
www.luxtec.com
List price: $1,350
FYI: Ergonomic design uses the head's natural contours to hold the light in place, says the company. Lightweight, durable translucent cable is split in two to evenly distribute the weight of the cable for comfort.

Luxtel
IsoLED
(978) 774-9136
www.luxtel.com/isolux/p_isoled.php
List price: $1,200
FYI: Xenon optics provide even, uniform light, edge-to-edge, with a variable spot size of 10mm to 110mm, says the company. LEDs have a 50,000-hour life expectancy. Waist-mounted battery pack allows freedom of movement and eases neck strain.

Microsurgery Instruments
Fiber Optic Light Source with Universal Clip
(713) 664-4707
www.microsurgeryusa.com
List price: $1,200
FYI: Microsurgery Instruments' Fiber Optic Light Source generates 4,200 foot-candles of light from a compact unit measuring 4.5 inches by 3.5 inches by 3.5 inches and offering 500 hours of lamp light. The company's Universal Clip-On Headlight, which connects to the light source with a 7-foot cable for mobility, conveniently attaches to loupe frames with an adaptor clip.

Products For Medicine
White Sun Surgical Headlight System
(800) 333-3087
www.productsformedicine.com
List price: $4,999
FYI: This headlight system provides illumination that is extremely bright to the eye, cool to the touch and easy on the budget, says the company. Backed by a three-year light source warranty, 1,000-hour lamp life warranty and 18-month headlight warranty, the White Sun system is offered with a free 30-day evaluation period for trial testing.

Sunoptics Surgical
Titan 400 Illumination System
(877) 677-2832
www.sunopticssurgical.com
List price: varies depending on options
FYI: The Titan 400 provides bright illumination and superior performance in the OR, says the company. The patented extended lamp feature means that the lamp ages at a fraction of the time of comparable xenon lamps, while new fan technology and advanced airflow design let the light source operate cooler and quieter than conventional systems.

SurgiTel Systems, a division of General Scientific Corp.
Universal Fiber Optic Headlight
(800) 959-0153
www.surgitel.com
List price: $800
FYI: SurgiTel's Universal Fiber Optic Headlight eliminates several drawbacks common to traditional headband-mounted lights, including weight, pressure to the user's head and incompatibility with certain types of loupes, says the company. The headlight works with a user's own eyeglasses or loupes and can be used with any fiber optic light source. Beam size and direction are easily adjusted for surgeon comfort and utility, adds SurgiTel.

Welch Allyn Lighting Products
ProXenon 350 Surgical Headlight System
(315) 685-2993
www.welchallyn.com
List price: $7,445
FYI: The ProXenon surgical headlight system — developed with input from surgeons and RNs in multiple surgical disciplines — addresses needs unmet by traditional systems, says Welch Allyn. Its small, loupe-friendly luminaire; large spot size range; lightweight, ventilated headband; durable, shielded, fiber optic cable and enhanced safety and ergonomic features of the light source are among the advancements aiming to provide long-term user satisfaction.