Your Complete Guide to Surgical Lighting

While easy to overlook, surgical lighting is among the most critical factors in a surgical environment. Without a high quality and dependable light source, surgeons are at a far higher risk of making mistakes that could seriously affect patient outcomes.

So it should come as no surprise that — in a study of surgeons in low-resource settings — an incredible 80% reported that the quality of their surgical lights represents a patient safety risk. Furthermore, 18% of these surgeons confirmed that they had directly experienced a negative impact on patient outcomes as a result of inadequate lighting.

In this article, we’ll give you a complete overview of the different types of OR lighting, their pros and cons, and the factors you should consider when choosing surgical lighting in your OR.

Modern surgical procedures are often highly complex, and surgeons must have clear visibility of even the smallest details while performing these procedures. Low-quality lighting in the OR is a dangerous and avoidable hindrance to surgical procedures that can contribute to:

• Poor surgery outcomes.
• Increased malpractice claims.
• Eye and neck strain and high surgical staff turnover.
• High operating room administration costs due to surgery cancellations and lengthy block times.

To avoid these issues, surgeons need a light source that maximizes visibility while minimizing eye fatigue and easing neck strain. Ideal lighting systems strike a balance between brightness, shadow dilution, temperature, and volume — all characteristics set out in detail in the IEC Surgical Lighting Standard.

Different Types of Surgical Lighting

Broadly speaking, there are three types of surgical lighting systems:

Overhead Lights are ceiling-mounted and equipped with LED bulbs. Usually, these lights can be adjusted to enable surgeons to direct light to the surgical site.

• Pro: These lights provide a lot of illumination and are a basic essential for any operating room.

• Con: Distances of up to 1.2 meters between the light source and its target can lead to a loss of light intensity. This can be reinforced with an additional light source, e.g., from a surgical headlight.

• Con: Due to their distance from the target site, it’s easy for light to be blocked by the surgeon’s head or arms, casting shadows over the surgical site.

Headlights are wearable devices that surgeons and other medical staff can use to focus light directly on the surgical site. They provide essential mobility and precision during surgical procedures and are ideal for minimally invasive and open surgeries.

• Pro: Light can be focused on a specific target and is highly unlikely to be blocked. This minimizes the risk of shadows.

• Pro: Due to their maneuverability, headlights are ideal for shallow and deep illumination.

• Pro: Due to their small size and wearability, headlights give surgeons maximum mobility and make it easy to adjust light direction and focus as needed.

• Pro: Many headlights are designed to fit between the surgeons’ eyes and/or loupe, and follow their line of sight.

• Con: Using headlights in an otherwise dark room may create too much contrast and can lead to eye strain. For this reason, headlights are invariably used in conjunction with overhead lights.

In-Cavity Lighting fixtures are used to provide visibility deep inside surgical cavities, and are used to supplement overhead lights and headlights.

• Pro: In-cavity lighting provides visibility into deep surgical cavities that other lights can’t match.

• Con: Heat management is essential for in-cavity lighting fixtures, as any heat created can potentially harm the patient.

So, which is right for your surgical facility?

Some form of overhead light is essential, as it ensures good illumination and keeps contrast to a minimum. However, as noted above, the risk of shadows and insufficient illumination on the operation site is significant.

At the same time, while overhead surgical lights are adjustable, this can cause problems as well. On average surgical lights are adjusted every 7.5 minutes – this unnecessarily distracts surgeons and increases the overall duration of those surgeries.

Simply put, overhead lighting and surgical headlights are better together. This way surgeons can ensure optimal illumination of operation sites at all times — removing the risk of shadows, while minimizing distractions and eye fatigue.

What To Consider: Essential Lighting Requirements

When choosing surgical lights, you’ll need to consider more than just the type of lighting system. As important as it is to combine overhead lighting with headlights, it won’t benefit surgeons if the quality of those lights is poor.

Here are the main factors to consider:

Luminance

Luminance — the quality of illumination — is measured in the amount of light falling on the surgical field in square meters and is measured in LUX. To give surgeons maximum visibility, surgical lights should offer high luminance without going so high as to cause glare or eye strain.

Since blood absorbs light, operating rooms require a higher level of illumination than most other environments. For this reason, the IEC stipulates that surgical lights should provide between 40,000 – 160,000 LUX.

Shedding a Brighter Light on LUX

LUX alone is not the “be-all and end-all” of OR lighting  – a study done at the Academic Medical Centre in Amsterdam found that standards for operating room lighting should include mandatory measurements for light-field diameters, light-field geometry and guidelines for the use of colored LED lighting in the OR.

The study concluded that maximum illumination is scenario dependent, and that the level of illumination (and distribution) on the surgical area was also dependent on light field diameter. In essence, large diameter light sources (seen below) resulted in more variation, with respect to visibility. This is because LUX measured at the middle-point of the overhead light source is not maintained across the entire light field.

What does this mean in practice? Variability (from large diameter light sources) equals inconsistency with light distribution. Having an additional light source (such as a surgical headlight), which is tighter in diameter, can help surgeons create consistent light distribution on the surgical field – resulting in more efficient and effective surgical procedures.

Comfort

For headlights, comfort is an essential factor that is rarely considered. Keep in mind that surgeons may need to wear headlights for 12 or more hours at a time. Under these conditions, comfort becomes more than a ‘nice to have’ — it’s an essential consideration.

Furthermore, uncomfortable headlights can easily distract a surgeon. Lights that aren’t easily adjustable can become uncomfortable. At best, this is frustrating for the surgeon — at worst, it contributes to poor patient outcomes.

Shadow and Glare Management

For obvious reasons, both shadows and glare are dangerous in a surgical environment and must be avoided at all costs. Shadows are a serious problem in operating rooms that rely solely on overhead surgical lights, but can be largely avoided with the addition of surgical headlights.

To reduce glare, you need more than just an absence of reflective surfaces — you need lights that provide consistent illumination across the entire pattern.

While some surgical lamps claim to offer exceptionally high LUX, this often leads to an uneven illumination where the center is much brighter than the rest of the pattern (as shown in the study above). This causes unnecessary glare and eye strain, which can be distracting for surgeons.

Heat Management

All light sources emit heat, but some are much worse than others. Operating lights that emit too much heat can cause tissue desiccation, negatively affecting patients’ recovery. They can also cause discomfort to surgeons, which can have a negative effect on patient outcomes.

You can use filters and lenses to reduce heat radiation. However, the best option is to replace outdated xenon or halogen lights with modern LED lights.

Color Temperature and Color Rendering (CRI)

Color temperature and CRI describe a light source’s quality and color in relation to daylight. In both cases, the best surgical and operating light sources simulate a bright daylight environment as closely as possible. The IEC provides specific requirements for both measures:

Temperature — between 3,000°-6,700° Kelvin. Daylight is 5,800° Kelvin.

Rendering — between 85-100 on the Color Rendering Index (Ra). Daylight is 100 Ra.

Sterilization

For obvious reasons, all surgical lighting equipment should be easy to clean and disinfect. If lighting includes straps or an adjustment apparatus, it should be antibacterial. All lighting equipment should be free from unnecessary crevices, as these can harbor bacteria.

Lifespan

Lifespan is an essential consideration for any equipment purchase. When it comes to surgical lighting, choosing LED lights is highly recommended as they offer much longer lifespans — up to tens of thousands of hours.

The Impact of COVID-19 on Surgery Lighting

COVID-19 has affected the medical industry in many ways. From a surgical perspective, these effects are mainly felt in two areas:

• The increased need for sterilization.

Hospitals must now have even more stringent policies and protocols to ensure surgical environments and equipment are thoroughly sterilized. This means it’s even more critical to ensure that surgical lights are easy to clean and disinfect and use antibacterial materials where possible.

• The increasing emergence of face shields in the OR.

In addition to the PPE already required in the OR, the current pandemic has increased the need for additional measures and safety equipment. To facilitate this, some surgical lamps can be retrofitted with a face shield to better protect patients and OR personnel.

In fact, a top medical device supplier in the US recently purchased headlights that were required to be compatible with a face shield, 60% of which were for outpatient surgeries. And it begs the question, how will the current pandemic alter healthcare and government policy moving forward?

Products like BFW’s Dover & Bristol-Plus can be easily fitted to a face shield to ensure minimal disruption during surgical procedures, while providing protection to the physician.

Optimize Your OR Lighting with BFW Surgical Headlights

While overhead lights are the most common form of surgical lighting, they aren’t enough to ensure full visibility of the operation site.

By combining overhead lights with high-quality surgical headlights, surgeons can ensure:

• Shadow-free, coaxial illumination of even the smallest surgical sites.
• A bright, consistent pattern of light that covers the entire field of view.
• A distraction-free operating environment that doesn’t require constant light repositioning.

BFW surgical headlights can be positioned coaxially between a surgeon’s eyes and loupes, allowing the light to fully illuminate the operative area. By making it easy for surgeons to illuminate the precise areas they are working on, BFW headlights reduce neck strain, eliminate distractions, and cut down surgeon fatigue.

To find out more about how BFW headlights can improve surgeons’ working conditions and promote better patient outcomes, visit our product page to see which surgical headlight solution is best for you.