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This report originally appeared in the August 2009 issue of DOTmed Business News

The surgeon may be the most important piece of the puzzle in an operating room, but don't discount the role overhead lights play in the procedure. After all, a doctor needs to be able to see in order to do the job. The body is full of tiny intricacies and anything helping a surgeon maneuver more accurately is always welcomed help.

O/R lights can be ceiling or wall mounted, recessed or mobile. The basic design of O/R lights combines the electrical source with a ring for commutators, or rotary switching devices, that are part of the mechanism to maintain contact while the light is swiveled.

For nearly 80 years, halogen lights were traditionally used for surgical lighting, but all that changed when Light Emitting Diodes (LED) lights came to market a few years ago. Companies like Stryker, Steris, Berchtold and Amsco quickly realized that hospitals would be demanding the new technology and started shifting their focus towards them.




"Technology is rapidly moving from halogen, which was very good technology with high intensity brightness, good quality lighting and at the time of the predecessor, extended bulb life," says Randy Tomaszewski, Vice President of Marketing for Skytron. "Ours lasted up to 5,000 hours. Now we've moved on to LED technologies and they are even greater in terms of the advantage of high intensity with extended life."

In fact, in most operating rooms, you can go 10 to 15 years without ever having to change the LED bulbs and by the time they are ready to be replaced, you might be looking to replace the entire fixture.

"More people are getting experienced with them and there are a couple of advantages with using them," says Bob Mighell, President of World Medical Equipment. "You don't have to worry about a light burning out in a surgery, so technically your bulb life is a lot longer and they run a lot cooler. LED lights just don't put out any heat."

The migration to LED is a once-in-a-century transformation for the industry. LED surgical lighting uses less energy and emits less heat, which makes it safer for the patient and more comfortable for the surgical staff. In addition, LED sources generate a very pure white light that is ideal for a surgical setting.




"Despite current economic conditions we are still seeing strong migration of customers to LED technology," says Chris Walters, Senior Product Manager, Surgical Solutions unit for Steris. "Now that LED surgical lights have been in the O/R for a couple of years, even the most skeptical customers are convinced of the benefits both in terms of performance and total cost of ownership."

There are many benefits to using LED technology. The challenge is that all the different manufacturers are doing LED lights in such varied ways, so it could make things confusing for the consumers.

"The thing about doctors is that they always want the newest toys and the latest and greatest technology and hospitals use new toys as a recruiting way to keep good talent, so if the money is there, LED is the wave of the future," says Paul Larson, Director of Operations for Beacon Surgical. "I think eventually, as prices come down and availability becomes greater, you will see a large portion of medical facilities will have them."

It makes sense as LEDs become less expensive, they will replace halogen technology. Gas discharge technology has been around for a while because it's energy efficient and had a longer life than halogen. However, the technology was never strongly adopted in the O/R because it required several minutes to warm up and the bulbs were expensive to replace. LEDs last even longer than gas discharge lights, turn on in microseconds, rather than minutes and provide unsurpassed color rendition.

Refurbishments Strong

With the state of the economy and uncertainty of health care reimbursements for the future, more medical facilities are tightening their belts and trying to make their lights last longer, repairing what they have and purchasing refurbished equipment more often.

Considering LED technology is so new, it rarely pops up on the used market and when it does, it usually sells quickly. Halogen is almost 100% of the refurbished market right now.

"There will always be a market for halogen. We're not worried about it not surviving," says Larson. "Buying refurbished lights is by far the best way hospitals can save money and still get like-new equipment. It's a huge investment and they can save an enormous amount of money and give up very little because the technology in halogen lights has not changed in years and years and years."

David Ogren, President of OMED of Nevada, agrees that LED won't take over the refurbished market for quite some time, if at all. "We have a continuous request for overhead lighting primarily because of the development of outpatient surgery centers and boutique health care centers or specialty centers," he says. "No one seems worried about the LED lights making halogen obsolete."

Refurbishing surgical lights involves a lot of work, but once completed, they are like new.

"The nice thing about halogen lights is that in most cases there is not any part on there that would make it obsolete," Larson says. "Every part is replaceable. You can put a new coat of powder on there, paint, add new parts; essentially your parts of the light head include the lens, reflector, focus mechanism, bolts, heat shield, covers...once you repair those and fix them up, you are basically getting a brand new set of lights."

Mighell explains that there are three main parts that need to be looked at during any refurbishment process-the mount with the arms, the light head itself and the control box. They are completely disassembled, repainted and then built back up.

"Each of those parts is separated from the whole. The control box is sent to our bio-med department and completely disassembled and any faulty components replaced," he says. "The arms are completely taken off center mounts and all bearings are gone through and replaced as necessary, all the wiring replaced and the head is taken off and disassembled. Arms all completely replaced. Lenses are examined, cleaned and often times replaced."

According to the used market dealers, the difference between buying new and used can be measured anywhere from 40% to 60% savings. The range for new ceiling mounted, dual head lights start at $25,000 and for the same light setup on the reconditioned side, it would cost approximately $9,500. Of course, prices vary by the type and size of the lighting used.

In and Out

These lighting systems are very technically advanced and shouldn't just be installed or de-installed by your local electrician or contractor. In fact refurbishers prefer to do most of this personally.

"We have customers who buy and want to install themselves but you have to tell them that there's more to it than putting in a few screws and bolts and having them function. You have breaking mechanisms that determine amount of drifting, the up and down movement, maneuverability of lights, how they are leveled," Larson explains. "Any time we purchase lights we ask to de-install them ourselves because if they are not taken down properly, they can be ruined."

Things that have been seen in the industry during bad de-installs include cable kits being ripped out, lenses getting scratched and pieces ripped apart.

"It's also faster. We like to de-install ourselves if possible because we can go in and do ten rooms in two days with a team of six people," says Ogren. "It's more important than the installation."

Challenges Exist

The O/R lights occupy the most important area of the ceiling, the area right above the patient. However, there are other pieces of equipment that also need this space, including C-arms (both mobile and ceiling-mounted), microscopes and navigation equipment.

"Coordinating how all of these pieces of equipment come together with in-field monitors and ceiling mounted equipment booms is becoming more of a challenge," says Walters. "The O/R ceilings are becoming as crowded as the O/R floors."

Another important aspect in choosing the correct lighting is to determine what sort of cases will be done in the room. Cardio-thoracic rooms usually require three lights because surgeons frequently have a secondary surgical site for vein harvesting. With LED lights, most other specialty surgical rooms only require two lights, even if they currently have three or four lights in the room.

"If the facility is planning to perform large open procedures, then they should consider a large and a medium light head. The large light head can cover the entire surgical site and the medium light head can easily be positioned anywhere extra light is needed," Walters says. "They also will need a light that has a broad spot size adjustment range so they can concentrate the light for smaller, deeper incisions, or widen the light pattern for larger surgical sites. High intensity is also an important requirement. Look for lights with 160,000 lux of intensity, the maximum allowed for surgical lights."

Price and familiarity also come into consideration for hospitals when they are looking to upgrade or change their surgical lights.

"The LED lights are 20% more expensive but when you look at the energy saving, the fact you are using half the energy and you never have to replace bulbs, it's really a win-win," Tomaszewski says. "But we have hospitals that have halogen lighting for six rooms and they are adding two rooms and they don't want to switch technology and have to change out everything so they will just buy two more of halogen, because it is a very good technology."

Keeping Up

Industry experts agree that health care providers should consider a lighting system that is modular and upgradeable.

"It's hard to predict how a facility's caseload will evolve over time, so it's wise to purchase a system that can grow as the surgical service grows," says Walters. "An upgradeable system enables facilities to add lights and monitors as needed, without requiring significant renovations. This will help them protect their investment over the long term."

The OEMs are thinking of the future and have started to design lighting systems that can integrate and change out without having to buy a whole new set of O/R lights.

"Everyone is familiar with halogen, which we will continue to offer in the market based on the fact that it is extremely cost effective," says Alan Campbell, Product Manager for Surgical Lighting, Berchtold USA. "Berchtold's approach isn't 'one size fits all,' and with our future-ready suspension, which can quickly swap heads between HID, Halogen, and LED, you can easily upgrade to future products and technologies."


Future Happenings

LED technology is evolving rapidly and manufacturers have a lot more flexibility in LED design these days.

Tomaszewski says Skytron is expecting HD technology to become a big part of its light future.

"The other thing people are going to be looking for and are already looking at are high definition camera systems built into light heads that still allow cameras to be portable and removed," he says. "All of our LED lights are high-def camera ready and all you need is the light head itself and the ability to deliver."

The demand will be for lights that tie into the overall integration of the operating room with the ability to deliver images from the field.

"The best is yet to come in surgical lighting technology," Walters says. "This will lead to a divergence in offerings as different manufacturers translate that technology in different ways. These innovations mean more efficient room designs for customers and more choices to address different needs."

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DOTmed Registered O/R Lights Equipment Sales & Service Companies
Names in boldface are Premium Listings.

Domestic
Morris Dweck, BH World, Inc., FL
DOTmed Certified
Dave Waterman, MRSBioMed, GA
Paul Larson, Beacon Surgical, IN
Randy Tomaszewski, Skytron, MI
Andrew Barnett, Cintech, Inc., NJ
Dave Ogren, OMED of Nevada, NV
Chris Walters, STERIS Corporation, OH
Wanda Krupinski, Berchtold Corporation, SC
Ken Smith, Traco Medical, Inc., SD
DOTmed Certified
Stephen Rousset, Medical Equipment Solutions, TX
Shannon Moore, STAT Biomedical Sales and Rentals, Inc., TX
DOTmed Certified
Juan Sandoval, Monterrey Medical Equipment, Inc., TX
Bob Mighell, World Medical Equipment, WA
DOTmed Certified

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