A Bright Idea for Your ORs

Your surgeons might have the greatest training, the most accurate technique and work with cutting-edge equipment, but they can’t fix what they can’t see. Lighted instruments — retractors, suctions and drop-in devices — solve visualization issues deep within body cavities by letting surgeons focus bright light exactly where they’re working.

Lighted instruments have been around for a while, but their designs continue to improve. Surgeons now have the ability to choose between acquiring specialized instruments that have built-in lighting, or lighting attachments that fit to their existing instruments. They’re available in single-use and reusable versions.

Some new battery-operated instruments don’t require a corded connection to a power source. “Our colleagues in the colorectal surgery world have always had a retractor that comes with a light, but they had to plug it into a machine,” says Sam Siddighi, MD, chief of female pelvic medicine and reconstructive surgery at Loma Linda (Calif.) University Health. “There were wires, and you don’t always want to use something that’s tethered.”

The lighted instruments he uses, by contrast, offer complete freedom of movement. “I just attach the light to my retractors and use it during surgery,” he says. “It’s battery-operated, and you can move it from one retractor to another as needed.”

When Dr. Siddighi first began using lighted instruments, his lighted suction wasn’t optimal because it wasn’t as bright as he needed it to be. But his new tools, which feature brighter LED lights, have addressed that issue.

“The brighter light makes the type of surgery I do safer because I’m able to visualize into really deep spaces, through the vaginal canal and beyond that,” says Dr. Siddighi. “I’m looking through this cylinder into this deep hole, and you need a lot of light to make sure you don’t place sutures on something that can be dangerous. So [lighted instruments are] good for both safety and accuracy. They’ve tremendously improved visualization into the deep spaces that I operate in.”

Marc Brozovich, MD, FACS, FASCRS, an associate professor of surgery at University of Pittsburgh Medical Center, is a general surgeon who performs a large number of colorectal surgeries. “Operating within the pelvis cavity is difficult enough as it is, without having difficulty seeing,” he says.

While he feels surgical headlights are useful, he prefers not to use them. “I don’t like wearing a headlamp — it gives me a headache,” he says. “Also, I find that the headlight is always a little bit off, where I’m looking isn’t where the light is, and I keep having to readjust it.”

Dr. Brozovich therefore uses lighted retractors and suction. He lauds their inexpensiveness, precision and illumination. The light is soft yellow or bright white, depending on the instrument he uses; he says both types of light are appropriate for his purposes and doesn’t express a preference, although your surgeons might.

One criticism Dr. Brozovich has of the lighted retractor he uses is that “it can get really hot where the light cord plugs into the lighted instrument, and at the tip of the light on the lighted instrument,” such that it could actually burn skin or tissue.

Overhead lighting can create shadows over the surgical site and, although it can be generally adjusted to different positions, it can’t be focused or intensified with exact precision over or into a very small or deep area.

Surgical headlights can greatly improve this situation, but they can have their own downsides. Headbands can slip or become uncomfortable, and older models can get hot, or require connection to a power source. Headlights also can cause the surgeon and staff to posture themselves awkwardly, which can lead to ergonomic issues and possibly even repetitive strain injuries. And they can be difficult to position as precisely as the surgeon may like. Overall, surgical headlights remain excellent tools, but they might not be as effective as some surgeons would like for deep cavity surgeries, while others may simply prefer not to wear them.

That’s where lighted instruments come into play. You have a lot of potential benefits to consider — precision, brightness, accuracy, lack of shadowing — and lots of products from which to choose. OSM