Surgical lights are a long-term investment that can either increase your surgeons' satisfaction or cause them innumerable headaches. To give you an idea of what to look for the next time you're in the market for lights, we asked a number of surgeons from different specialties to tell us what they love and loathe about their lights. We hope you'll find their thoughts illuminating.

The four "must-haves"
According to the surgeons with whom we spoke, surgical lights should have three key features: smooth maneuverability, true color, shadow-free illumination, and long-lasting bulbs. Here's what they said about each of these factors:

Smooth maneuverability: Lights that are easy to maneuver and rotate around the surgical site rate high with surgeons; maneuverability is particularly important during bilateral procedures. "Getting the lights to multiple sites can be difficult, because the general maneuvering is sometimes stiff," says James Yates, MD, president of the Center for Cosmetic Surgery, Camp Hill, Pa. William Kelly, MD, a plastic surgeon at the Houma Outpatient Surgery Center, Metairie, La., agrees: "I would really like a light that can make a smooth 360? rotation around the surgical site, so I can get light anywhere quickly and easily." According to Scotty Farris, an equipment planner based in Frisco, Texas, higher-end (and often more expensive) lights often feature better suspensions, which means better maneuverability. "High-end suspension will allow you to rotate the light around the axis," he says. "Less expensive models can't rotate 360? because of the location of the electrical wiring."

Another way to get better maneuverability is to purchase smaller, more manageable lights.According to Dr. Yates, surgical lights that were once around four to five feet in diameter are now more like two or three feet in diameter. Victor Bruno, MD, a general surgeon with the Center for Ambulatory Surgery, Mountainside, NJ, adopted this strategy of purchasing smaller lights and finds them very easy to maneuver. However, Mr. Farris warns, smaller lights do not always have the same level of illumination, and even if they do, sometimes they have fewer reflective surfaces, which makes them appear less bright.

True color: Surgeons use OR lights to provide more than just illumination to the surgical site. They need the light to see the color of the patient's skin to monitor circulation and temperature. But it's not just the intensity of the light that's important. Says Dr. Yates, "To be sure that you are getting the patient's actual skin color, your lights need to be true in color." The best way to get true color is to get lights are as close to pure white in color as possible. The whiter the light, the more natural the illuminated area will appear. Light manufacturers measure the trueness of the color using a color rendering index (CRI). A CRI of 100 is perfect, meaning it is truest representation of color possible.

Shadow-free illumination: The surgeons with whom we spoke recommended looking for lights that provide shadow reduction. These lights use a series of reflectors that deflect the light onto many different areas, so the light can reach below a surgeon's hands or instruments. Many surgeons with whom we spoke indicated that shadow-free illumination is particularly critical during small detail work where the shadow from a surgeon's hand could block out any light to a small surgical site. Some surgeons believe that using multi-bulb lights also reduces shadows because the bulbs typically shine in multiple directions. However many single-bulb lights offer a larger illuminated area.

Long-lasting bulbs: Look for lights that use long-lasting bulbs, and make sure that the bulbs are easy to replace. Difficult-to-replace bulbs were a pet peeve of many of the surgeons with whom we spoke, but a few manufacturers have found solutions to this problem. "Many of the newer lights now have snap in/snap out bulbs, which don't require any extra tools," says Mr. Farris. "But older lights and some less expensive models require removing the cover plate with a screwdriver."

If you do have lights with bulbs that are difficult to change, it may be wise to keep a back-up light on hand. According to Dr. Yates, when a bulb goes out in his office surgery suite, it takes a while for the bulb to cool down and another 15 minutes to change it. But his OR lights have multiple bulbs, which provide enough light to continue with a procedure if one was to burn out.

According to Mr. Farris, single-bulb lights and multi-bulb lights both have their advantages and disadvantages. Most multi-bulb lights can be used even if one of the bulbs burns out, but the downside is they typically give off more heat.

Several of the doctors we talked to also mentioned that bulbs may be very expensive to replace. They can range from $20 to $200. Mr. Farris recommends talking to the manufacturer and finding out what bulbs the light uses, how long a bulb's average life is, and how expensive the bulbs are to replace. Include all of these factors in your cost analysis to determine the "true" cost of the light.

How to get the best lights
In some cases, surgical lights that may be good for one facility may not work as well in another. Here's what our experts had to say on finding the lights that are perfect for your center and how to take full advantage of them when you find them.

Consult your surgeons first: Several of the surgeons with whom we spoke were very involved in selecting the surgical lights in their facility, and all of them are happy with the lights that they have. Says Lawrence Pinkner, MD, president of the American Association of Ambulatory Surgery Centers, and a plastic surgeon at the SurgiCenter in Baltimore, Md., "We showed the surgeons the information about the lights we were looking at and got feedback from them before making a final decision. We've had our lights for 13 years and aren't looking to replace them in the near future." He also adds that your surgeons may know of models they use at other facilities that they may recommend for your facility.

If you are a multi-specialty facility, be sure to consult surgeons from all different specialties. Look into lights that will easily adapt to fit a variety of needs. "Many plastics procedures are performed on the face, and we traditionally have our lights mounted on the ceiling," says Dr. Pinkner. "But some specialties, like gynecology, may need two smaller lights that are able to reach many different angles."

Try before you buy:
Before deciding on lights that could be with you for a while, do everything you can to try them out first, experts recommend. Ask companies if you can visit a nearby facility that uses the lights you're interested in, or check out the lights at the company's showroom or an equipment exhibition. Some companies also offer small demo models that you can check out. And in some very rare cases a company may allow you to try the lights. Says Mr. Farris, "If you are replacing a number of lights at your facility, the company may install the lights for a trial period."

Install lights properly:
Even when you've found the right lights, the work isn't done-proper installation is key to making sure they function as promised. Ceiling mounted lights that are not properly installed may drift. Keeping OR lights from drifting is usually related to the installation. "My most frustrating experience with lights was at a facility where the lights would not stay put. They would drift out of place throughout the procedure," says Dr. Kelly. The lights are delicately balanced and adjusted to take full advantage of their suspensions, provided they are installed perfectly level. Mr. Farris encourages clients to have the vendor, rather than a third-party contractor, install the lights to ensure that they are properly mounted.

Finally, when you're shopping for lights, remember that you don't have to bust your budget or limit yourself to brand names. Equipment planner Peggy Beddingfield of Medical Source Systems, Brentwood, Tenn., says that a theme she hears over and over from client surgeons is as long as the OR lights are reliable with good quality illumination, brand generally does not matter.

When buying new lights, Mr. Farris recommends determining what features are most important and what you can get within your budget. You can also try buying demo models or refurbished lights. "Buying demo models is always safe," he says. "They may not be cosmetically perfect, but the manufacturer should give you the same warrantee as a new light." According to Mr. Farris a surgical light's moving parts (such as the suspension but not including the reflectors and lenses) have an average life of 15 years; after that they may need to be rebuilt. So if you are going to buy refurbished lights, be sure the dealer is dependable and checks the light out thoroughly.

In short, find out what your surgeons want, do your homework, and don't be afraid to bargain hard. Your staff and surgeons will be appreciating your high-quality, dependable lights for years to come.