FINDING THE LIGHT What should you look for during a surgical headlight trial?

Four years ago, our physician-owned surgical specialty hospital underwent an extensive surgical headlight trial, where we examined the costs, ergonomics and performance in surgery of both tethered coaxial surgical headsets and cordless battery LED headsets. After studying the options, we found some things that were great — and not so great — about both (see "Head-to-Head Headlight Comparison"). In the end, we purchased 8 LED and 3 coaxial headsets. Fortunately, our surgeons still love them. Here are 5 takeaways that may help you make a successful purchase.

1. Know your audience
Different surgical specialties have different lighting needs. Hand, ENT, oral maxillofacial and plastic surgery are typically performed at shorter working distances of 14 to 18 inches, with relatively more shallow surface surgical exposures. On the other hand, minimal access posterior, lateral and anterior spine surgeries involve small incisions with deep working portals and long working distances of 18 to 24 inches. Most companies tout their headlight's lux number — the higher the lux, the brighter the light. Surface-work surgeons may be fine with lightweight devices with lower light output while your spine and general surgeons likely require more robust lighting with larger, tightly focused spot illumination. Knowing these differences can shape your shopping experience.

2. Study the options
My hospital looked at 2 headlight options — tethered coaxial systems and battery LED cordless headsets. Personally, I enjoy the freedom, light coloration and uncluttered environment my LED headlamp provides. But, there are other options out there. Bulb types used in contemporary surgical lighting include halogen, xenon and metal halide with their light transmitted via coaxial cables from a light source. Solid-state light-emitting diode (LED) bulbs act as their own source, needing only an electrical current for power. LED lights need only 7 to 13 watts of power, so battery-powered models are a new option. Each of these styles has benefits and drawbacks.

Some surgeons enjoy tethered fiber optic headlamps since they are relatively lightweight and provide excellent illumination. However, the coaxial cables are fragile and expensive. They are easily damaged from routine handling, which degrades the cable and may cause 30% to 40% loss of light transmission over 18 to 24 months of heavy use. There's also the cost of bulbs. Xenon bulb replacement typically costs $600 to $900 every 200 hours of use.

Compare that to LED bulbs, which are typically rated for 20,000 hours or 5 or more years of use. Battery-powered LED headlights also give you increased mobility and de-cluttering of your ORs. No "unplugging" is needed during cases where you work on both sides of the table, and there is no light box to move. LED lights do have their downsides, though. Battery life is one concern some have, though I've found that after a few weeks battery life is easily predictable, anticipated and not problematic. If I know I'll need a new battery pack, it's easily "hot-swapped" in 30 seconds or less by the circulating nurse. Additionally, LED bulbs do "age" and can become more blue-hued with time. In our trial, we found that a light temperature or coloration of 5200-5500K was ideal.

3. Conduct a thorough trial
There are 2 ways not to buy your headlights — purchasing based off of price and lux number alone, or going to a trade show and picking out one that seems bright and comfortable. A trial is the only way to truly see what works and what doesn't.

Here's what we did. We brought in 12 vendors to set up a mini-trade show in the boardroom at the hospital. Administration, biomedical engineering, surgical room nurses, surgical techs, assistants and surgeons spent an entire morning trialing the devices. We then took their fantastic input and trimmed the field to 4 devices.

Then, a select number of physicians trialed those 4 devices in surgery. Each surgeon used the headlight for a minimum of 5 to 6 hours in the OR — or a full day's worth of a variety of cases. Personally, I used each model for 7 days. This really helped me see the nuances with each option — how the color affects the tissue, luminescence, spot fill, beam focus and compatibility with my through-the-lens (TTL) and flip-up surgical loupes. I also could look at simple, but important, factors like wearability, ergonomics and how often I would "bump heads" with my surgical assistant.

Not every surgeon was involved with our trial, but that was okay. It ensured those involved were passionate about choosing the right light. When conducting your trial, just make sure that you have surgeons from each of your headlight-wearing specialties involved, and that you have both surface-work and deep-cavity docs represented.

4. Watch for the little things
You know the big decision factors your surgeons are looking for — luminescence, comfort, spot fill, coloring — but also ask them to look for the little things that can end up making a big difference in the OR. Holding an extended trial will help determine if there are any of these kinks with the unit.

For example, pay attention to the headset's compatibility with the surgeon's telescope flip-up loupes (this is less of a problem with TTL loupes). When a surgeon wears both of these items for an extended amount of time, they can become tiring and uncomfortable. You certainly don't want to purchase a $6,000 headlight if your surgeon's $2,200 loupes can't even be used with it.

Also consider the ergonomics of the battery pack if using cordless options. While typically these packs are lightweight and easily hot-swappable, there is a difference between one that lets a surgeon, while sterile, flip the switch to turn it on or off, and one where an un-scrubbed assistant is needed to turn the switch on the back of the headset.

5. Keep a few options on hand
While finding a single option that all your surgeons love is ideal, sometimes it's just not possible. You may even come away from a trial with more than 1 headlight purchase. This is particularly true in larger hospitals or those multispecialty facilities that have both surface-work and deep-cavity procedures. In these cases, I suggest purchasing "fleets" of headlights, instead of a bunch of individual units, so that you have plenty of battery packs and wall chargers.

Some facilities find success in having both tethered fiber optic, and cordless LED options. Having both can help satisfy the needs of a broad range of surgeons and specialties. Other facilities keep 2 LED options on hand — a lighter option with less intense light for surface work, and a more robust option for open procedures. I have 2 LED cordless headlights and use both extensively — a lightweight model for surface incisions on MIS spine cases just before using the microscope, and a high-output option for my spine procedures where I work with a general surgeon. Note that this shouldn't dramatically alter your costs since the styles of lights tend to be close in price. Instead of purchasing 20 units of the same LED model, you would just purchase 10 and 10 through the same vendor and still ask for the bulk-buy discount.

If you're trying to move away from your coaxial units to cordless LED headlights, consider keeping 2 or 3 of the old sets on the shelves after you've made your purchase. This lets the reluctant surgeon choose when to switch to the LED model — which will happen when he sees the mobility and quality of his colleagues' cordless headlights.