ENLIGHTENED "For otolaryngologists, headlights are a staple. We couldn't exist without this assistance," says Sanford Archer, MD.

The portable illumination that surgical headlights bring to the table is invaluable for visualizing open, small-cavity procedures. Given their use in ENT, general, colorectal, spine, cosmetic and other surgeries, headlights may seem like a difficult accessory to get all your physicians to agree on when trialing the options to outfit your facility. But it's highly likely they'll reach consensus on the following 4 factors.

1. Brightness
It's no surprise that physicians who routinely depend on headlights to enhance their view of the surgical site rank the brightness and focus of the illumination as the most important factor in their choice of equipment.

The good news is, that still leaves you with a lot of options. "The light intensity and light transmission in almost all the lights available now are very good," says Guy Voeller, MD, FACS, a professor of surgery at the University of Tennessee Health Science Center in Memphis and a former president of the American Hernia Association.

In making your purchasing decision, trust the hands-on, eyes-on trial and don't rely too much on marketing materials. "The brightness of light as quantified in lux numbers isn't always an accurate representation," since the light that reflects off of shiny instruments at the site can influence what you see, says Sanford Archer, MD, a professor of otolaryngology and head and neck surgery at the University of Kentucky College of Medicine in Lexington.

Never mind the numbers, Dr. Archer advises. Put the light to the test in real situations, the narrow cavities and the types of cases you'll see. "It's critical to trial headlights at the focal lengths needed," he says.

Stephen Cohen, MD, MBA, FACS, FASCRS, who practices at Atlanta (Ga.) Colon and Rectal Surgery and who chairs the department of surgery at Southern Regional Medical Center in Riverdale, Ga., agrees. "I always trial headlights on cases where I know it's going to be dark," he says. "In the pelvis, where you're constantly looking around corners, or the anorectum, where the higher you go, the less light there is."

CENTER OF ATTENTION "Headlamps create a focused, intense beam of light, right where you need it," says Guy Voeller, MD, FACS.

2. Consistency and control
In addition to the light's depth of focus, the width of its illumination is important. "You don't want a little beam, you need a wide field of light," says Dr. Cohen. "Not 2 inches across, but 6 or 7 inches." Preferably, this field of light should be a consistent, even spot, not brighter in the center and dimming on the edges.

The source of this light is another factor to consider. Most headlights use either filament-lit bulbs (such as halogen or xenon bulbs) or solid-state technology (light-emitting diodes), and longevity and the cost of replacement components can play a part.

"Traditional halogen bulbs delivered slightly yellow light and were not as bright," says Dr. Archer. In contrast, "xenon was incredibly white, but it cost $500 to $600 per bulb.

"LEDs go 20 years," he adds, "but as we've seen in overhead lights, the problem with LEDs is they don't give off as focused a beam. They need reflectors. LEDs are bright but diffused light."

Since the point of headlights is to focus an intense beam of light directly where you're looking, without the repositioning required by overhead OR lamps, the ideal device should be stable. "You want something that doesn't move around very much," says Dr. Cohen, and remains in place without drifting or frequent readjustment.

3. Comfort and ergonomics
The brightness of the light may be the leading factor in choosing a surgical headlight, but as wearable equipment, its design must take the wearer's comfort into account. Especially since "the longer you wear it, the more uncomfortable it will get," says Dr. Archer.

The right fit isn't just a matter of comfort over the course of a day's cases, but also of long-term ergonomic health and occupational safety. "You can tell which surgeons have relied on headlights for many years," says Dr. Voeller. "They have scars on their necks from ruptured disks they had to have repaired."

Indeed, in early headlight models "the focus was clearly on providing light, not on the comfort of the user," notes Dr. Archer. Manufacturers have made great strides since those big, bulky, hard plastic helmets, though. Now lightweight headbands, padded pressure points, ventilated construction and compatibility with eyewear are the key.

Headlights that connect, via fiber optic cables, to light source boxes (which are plugged into electrical outlets) also feature lighter, less cumbersome cords, but make sure the cords are long enough to allow the wearer to move around the patient and table without feeling constricted or having the headlight pulled off his head, says Dr. Cohen.

"You can't really tell how something fits until you put it on, like shoes," says Dr. Archer. Dr. Voeller adds that potential headlight buyers should take their time when trying them on. "Multiple attempts with each device. Not just once or twice, but a good hard test for about a week to make sure."

4. The cordless option
Recent years have seen the increasing availability of cordless, battery-powered headlights. In terms of mobility, a unit that's not tethered to a light source box provides a solution, but depending on the model, it might not satisfy the requirements mentioned above.

"I have yet to find a cordless version that's worth my time," says Dr. Voeller. "The weight of the battery pack and the intensity of the light have been a problem when I've trialed them." Most of the surgeons he knows use corded headlights, particularly models that are easy to plug in and lightweight to wear.

Dr. Cohen notes that, in addition to the uncomfortable weight of a battery pack on the waist of scrub pants or a headband, it also generates a fair amount of heat during the course of its use.

Plus, any battery-operated device brings with it issues of battery life. "The biggest weakness of the battery pack headlight is, if it's not charged regularly, it will fail you," says Dr. Archer. Even if it is fully charged, "it will fade over time, it'll lose light quality. The batteries do dim on you. A light source, on the other hand, gives consistent brightness."