Garden City University

Different zones of OT Complex

Medical
Instrumentation

lect. Hala Awad Alkareem Ali

Medical Instrumentation

Lecture (2)

surgical lights
Introduction

• Surgical lights, also known as operating lights, are mainly used in hospital operating
rooms (OR) and ambulatory surgery centres (ASC).
• Surgery lights can also be used in various locations throughout the facility to provide
high-quality lighting for procedures. Examples include emergency rooms, labour and
delivery, examination rooms, and anywhere where procedures are completed.
• Clinicians, surgeons, and proceduralists use them. A surgical light illuminates the
operative site on a patient for optimal visualization during a procedure.
• Surgical lights can provide hours of bright light without excessively heating the
patient or staff. Various lights are available to provide optimal visualization during
surgery and procedures.
• An examination light is used during medical exams, while operating room lights are
used during surgical procedures.
What is important in a
surgical light?
• Surgical lights are medical devices designed to
effectively illuminate the patient’s body during
surgical procedures, diagnostics, or treatments.
• These lights must follow a strict set of specifications
to ensure efficient and effective illumination that
leads to improved visibility and better patient
outcomes.
HISTORY OF SURGICAL
LIGHTS
• Before electricity allowed lightbulbs to illuminate
an operating room, candles were used as a light
source during a procedure. Additionally, surgeries
were performed during daylight hours so surgeons
could use the natural sunlight for illumination.
• Surgical lights, as recognized today, have evolved
over a century since electricity was first discovered
in 1879, with surgical light manufacturers
continuously working to improve lighting conditions
for surgeons and OR staff
TYPES OF SURGICAL
LIGHTS
• There are various types of surgical lights,
and each type plays specific roles in
illumination before, during, and after a
medical procedure. They can be categorized
by lamp type or mounting configuration.
Two common types of lamps are
conventional (incandescent) and LED (light-
emitting diode) lamps.
• Surgical lighting configurations may include
ceiling-mounted, wall-mounted, or on-floor
stands. Depending on the model, a surgery
light may also be used in all three
configurations
Surgical lighting
configurations may include
• A ceiling-mounted light can be mounted on a fixed
point on the ceiling of a procedure room.
• is designed to provide comfortable, high-quality
illumination that can be adjusted to meet various
clinical needs. A below-ceiling dome offers 56
degrees of lighting articulation for optimal aiming
and versatile installations in any clinical setting.
Surgical lighting
configurations may include
• wall-mounted lights are mounted on a
wall of the OR. The wall-mounted
configuration is more often used with
examination lights than surgical lights.
• For greater mobility, floor-standing
surgical lights are standalone and typically
on wheels, enabling them to move from
room to room. Mobile floor-standing
lights are often used in examinations. All
three types play an important role in
illuminating a surgical site during a
procedure.
common types of lamps
Incandescent Lighting
• Halogen bulbs were historically considered conventional surgical
lights and utilize a type of incandescent bulb filled with halogen gas
to produce light inside the lamp.
• Halogen enables the filament to run at a higher temperature
because, although the tungsten is evaporated off the filament faster
at the higher temperature, the halogen chemically reacts with the
evaporated tungsten to form a tungsten halogen compound, which
diffuses back to the filament where the higher temperature causes
it to separate into tungsten and halogen, depositing the tungsten
back on the filament.
• Their lower filament-correlated color temperature at 3,000K gives
them their typical orange-yellow, warm-appearing cast rather than
white.
• standard halogen lights have an average short life span
of approximately 1,000 to 3,000 hours and often die
abruptly.
• When lit 24 hours a day, seven days a week, this
translates into about six months of life. Changing bulbs
every six months can become costly to an organization
over time. If halogen lamps are touched with bare
hands, even when cool, the oil from the person’s fingers
can heat, shortening the bulb's life. They emit a
substantial amount of heat, making them hazardous to
touch, especially when turned on, and uncomfortable to
work under while performing a procedure.
• the glare from halogen lights became a risk as it
caused fatigue and eye strain when surgeons looked
away from the surgical site into glaring lights and
needed time for their eyes to adjust when refocusing
their attention on the surgical cavity. In fact, in the
early 1900s, some surgeons began using dark-colored
cloth and sheets during surgery to minimize glare.
The black cloth did not allow for immediate
assessment of clean versus soiled linen, so eventually,
the standard became to use green linen to reduce
glare and allow for the visualization of soiled material.
common types of lamps

• LED Lighting
• in the early 2000s, LED became a standard offering in many
industries, including ORs and other procedural areas, and
surpassed conventional halogen light sources as the
preferred light source used during surgical procedures. 1
• They are solid-state semiconductor devices that emit light
as currents flow through them. They have a more refined
energy usage and require significantly less energy than a
halogen to produce equal to higher quality illumination.
• The plastic encapsulant and the lead frame compose most
of the bulb’s structure, and the light-generating chip is
comparatively small.
• Light is generated inside the chip, a solid crystal material, when
current flows across the junctions of different materials.
• The spectral emission of the LED light depends on the materials
used to form the semiconductor, the most common combinations
being aluminum indium gallium phosphide and indium gallium
nitride. The composition of the materials determines the
wavelength and color of the light (i.e., red, yellow, green, blue, or
white).
• Initially, LED surgical lighting used a combination of red, green,
blue, and white LEDs to achieve a bright white illuminance. This
strategy was the primary means to achieve high light output
superior to what using all-white LEDs could produce.
• Unfortunately, the light would change color when a hand is placed
in the sterile field, which blocks one or more colors.
• LEDs can be extremely small, durable, reliable, and have a much higher
bulb-life rate than conventional lighting. The current determines the light
output of LEDs through the semiconductor and its temperature.
• LEDs can have a long life of up to 60,000 hours when using the maximum
current recommended by the manufacturer.6 However, most are generally
rated for 25,000 to 40,000 hours of full light, and rather than failing
abruptly like halogen bulbs, they gradually fade in brightness. In terms of
luminous efficacy, LED lights used during procedures typically do not
require a filtering media, as is needed with halogen surgical lamps, which
contributes to their relatively low luminous efficacy.
• LEDs offer higher efficacy, allowing for reductions in connected load of
50% or more, virtually eliminating the problem of infrared radiation
caused by excessive heat, with the potential for additional energy savings
through constant-color dimming and reduced cooling load in the OR
• he latest LED products are high-flux and have luminous
efficacies up to 100 lumens per watt (lm/W) and
higher.6 Because past OR practices involved turning lights up
to full intensity, original perioperative staff would do the same
with LED lights. Unfortunately, this created distortion. To
avoid distortion, standard practice begins at a 50% intensity
level. Many surgical lamps offer enhanced properties to
mitigate shadows cast by the surgeon and perioperative team;
some products also allow color adjustment.8 Their availability
in a wide range of spectral power distributions (SPDs) permits
the development of spectrally tunable surgical luminaires,
where an array of LEDs with distinct SPDs can be mixed to
produce a variety of spectra from a single luminaire.15
High-Intensity Discharge
(HID) Lighting
• Gas-discharge lamps generate light by sending an electrical discharge through
ionized gas. High-intensity discharge (HID) lights are electrical gas dischargers
that use an electric arc to produce intense light. Like fluorescent lights, they also
require a ballast.
• They provide the most extended service life out of all lighting types. HID surgical
lamps are commonly used for outdoor lighting and in large indoor areas. They are
most suitable for applications that stay on for hours.
The three most common types of HID lights are:
1. Mercury vapor lamps
2. Metal halide lamps
3. High-pressure sodium lamps
• Since most HID lamps produce light that is either very cool white/blue or warm
white/yellow, they are generally not used in applications where the aesthetic
quality of light is essential. Also, some HID bulbs require an extended warm-up
time and are unsuitable for applications where lights are turned on and off
regularly.
THE DIFFERENT TYPES OF
LIGHT
• The primary function of surgical lighting is to illuminate the operative site on
and/or within a patient for ideal visualization by OR staff during a surgical
procedure. With proper lighting, operating room staff can achieve a higher
level of efficacy during surgery and reduce the risk of complications.16
Specular
• Specular lighting stimulates the bright spot of a light that appears on shiny
objects, such as surgical instruments. Specular highlights are more inclined to
the color of the light than the color of the object it appears on. This light
retains its reflective qualities.
Diffused
• Diffused lighting stimulates the directional impact a light object has on an
object. This is the most visually significant component of the lighting model.
The more a part of an object faces the light source, the brighter it becomes.
• Diffuse lighting is brighter the closer its fragments are aligned to the light rays
from the light source
REQUIREMENTS FOR
SURGICAL LIGHTS
• Surgical light requirements vary depending on the
lighting system's type, brand, and model. The
brightness of a surgical lighthead is measured in Lux
and typically does not exceed 160,000 Lux. The
approximate dimensions are 400-700mm for a
lighthead diameter, and the approximate weight is
45kg. The weight can vary depending on the number of
lightheads attached to the system. The lifespan of a
surgery light is measured in its L70 value, which is how
long the light will last until its brightness is 70% of its
original value. Today's surgical lights typically last
between 40,000 to 60,000 hours of use.
OPERATING ROOM
LIGHTING METHODS
• Quality lighting is vital for every OR; the lighting
method depends on the needs of the staff and
patients. Three of the most common methods are:
1. Overhead/operating lights
2. Headlights/illuminated loupes
3. In-cavity lighting
 Overhead/Operating Lig
hts

• Overhead/Operating Lights are typically LED or incandescent and can be

mounted on a ceiling or wall. These operation room lights have handles that
allow the surgeon and perioperative team to adjust the lighting for the best
visualization, helping to prevent glare and optimize surgical site
visualization.
• Challenges with overhead lighting include the potential for not precisely
illuminating the surgical site, resulting in the operative site being flooded
with large amounts of light that do not permit exact spot patterns to see far
and wide into the cavity.4 This can create a diffused light pattern with
strategic lenses
• ALYON™ Surgical Lighting System offers precise
illumination and adaptive lighting for superior
optical performance for ORs and ASCs. This surgical
light has ten different intensity settings, four spot
sizes (focal point sizes), and four different color
temperature options, with 160 ways to customize
your lighting experience.
• The HarmonyAIR A-Series Surgical Lighting System
redefines optical performance through excellent color,
contrast, clarity, and control. A unique peninsula
design provides optimal illumination at the surgical
site, including deep cavity procedures. You can
automatically maintain constant light intensity even
when the light is adjusted or moved during a
procedure.
Headlights/illuminated loupes

• Headlights are wearable technology that provides brightness,

dependability, and small spot size for surgeons by enabling light to
follow the surgeon's attention and enhance mobility and shadow-free
illumination. These headpieces can be battery-powered or connected to
a standalone light source with a fiber optic cable. Headlamps can be
uncomfortable, resulting in head and neck pain after an extended
period. When connected to fiber optic cables, movement is limited,
requiring the surgeon to detach the cord for the light source and
reattach it as it moves around during the procedure. They can also
increase clutter and become a tripping hazard in the OR
In-cavity Lighting
• In-cavity lights enable illumination deep inside surgical
cavities. In-cavity lighting is a practical option if current
overhead and headlamp lighting are inadequate. This light
source is generally fixed on its own or attached to a
surgical instrument outside of the sterile field or combined
with fiber optics to eliminate factors such as added heat.
• This type of lighting is only practical for some surgical
cases. First, in-cavity lighting can be cumbersome and
emits very little light. It can also become an infection risk
because it is another item placed inside the patient and
requires larger incisions, whereas modern surgery
endeavors tend to be minimally invasive.
CHOOSING THE LIGHTING
FOR PROCEDURES
• surgical lighting is one of the most critical factors in
the OR environment. The type of surgery
performed tends to influence the surgical lighting
needed. Without the correct light source, the
surgeons’ risk of making mistakes increases and
could affect the following:
• Surgery outcomes
• Increased malpractice claims
• Surgeons need the correct light source that
maximizes visibility and efficiencies in the OR
Lighting for Open
Surgery
• Traditional open surgery can utilize overhead
lighting when the operative site is not deep within
the patient. LED lighting is the most conventional
light source used for open surgery. Emphasizing the
reduction of shadows is crucial for open surgery.
Obstructions are expected between the light source
and the surgical site, i.e., head, shoulders, hands,
instruments, etc
SURGICAL MICROSCOPE
• A surgical microscope, also known as an operating
microscope, is an optical microscope specifically
designed for microsurgery.
• The surgical microscope provides adjustable
magnification, bright illumination, and clear
visualization of the surgical field and has been used
more progressively in operating rooms.
• State-of-the-art surgical microscopes are integrated
with various imaging modalities, such as optical
coherence tomography (OCT), fluorescence imaging,
and augmented reality (AR) for image-guided surgery.
Industry standard IEC
60601-2-41
• In 1977, a series of technical standards were developed by
the International Electrotechnical Commission (IEC), to
ensure the safety and essential performance of medical
electrical equipment. In 1990, a committee of international
experts met to devise a dedicated section defining surgical
lights. The IEC Standard 60601-2-41, titled “Particular
requirements for the basic safety and essential
performance of surgical luminaires and luminaires for
diagnosis”, has been in effect since December 1999. Since
then, several revisions have been published. The current
standard, presented as recommendations for international
use, is IEC Standard 60601-2-41:2021.
Central illumination:
The overall
measurement of
lighting
• Illumination is a intensity
measure of the intensity of light
that hits or passes through a surface, as perceived
by the human eye.
• It is measured in lux, the standard measurement of
one lumen per square meter.
• It is measured with a lux meter, a device that
measures light intensity.
• More illumination is not necessarily better. Too
much illumination can cause glare, contrast loss,
and eye fatigue. Different types of procedures also
require different amounts of light; visibility into a
deep cavity requires more illumination than a
surface wound. In surgery, the quality of light
matters more than the amount of light.
Light field diameter:
The horizontal plane of available
light
• The light field diameter defines the plane surface
where the light will be available — the width of
available lighting on a horizontal plane. The central
illumination is where the amount of light is at its
maximum; moving away from the center, the light
will smoothly decrease.Two diameters of light are
measured.
• There is no minimum or maximum diameter indicated inmthe IEC
standard because the diameter of the light should be adapted to the
incision size. It should:
• Cover the full surgery incision with no dark areas to maximize visibility
• Avoid peripheral light reflection by having too much light illuminating
the surroundings of the cavity
• Each OR hosts a wide variety of surgical procedures, each with different
light field requirements. The challenge of surgical lighting is maintaining
the same amount of light whether the light field has been adjusted for
a large or small incision size. This is a complex technical challenge, as it
is easier to concentrate light on a small field than a large one. For many
lights, the technical features are mentioned for the small light field, but
can drastically decrease when enlarging the light field diameter.
Lighting homogeneity

• Homogenous lighting reduces glare. The IEC standard

defines homogeneity to limit bright and glaring light
at the center of the light field (EC,Ref , the point of
maximum illumination, noted above) contrasting with
darkness. To evaluate the homogeneity, the diameter
ratio is used:
• d50/d10 > 0.5
• That means that d50 must be at least half of d10. The
closer d50 is to d10, the more homogeneous an well
distributed the light field is on the horizontal plane.
 Volume of light:
The vertical plane of available
light
• Surgeries are three-dimensional procedures,
ranging from the incision point at the surface to the
deepest cavities.
• This is why we define not just the diameter of light
on the horizontal plane, but also the volume of light
on a vertical plane, also called the column of light.
Shadow management:
• Measurements of central illumination, light field diameter, and central
illumination are performed on the light head alone. Shadow
management adds humans into the equation.
• During a surgical procedure, surgeons stand between the light head and
the patient; their hands and heads cast shadows that can affect visibility
into the surgical cavity. Shadow management defines how the light is
designed to assure adequate illumination to compensate for these
shadows. The remaining light is also known as the useful light.
• If the shadow management is poor, the useful light available inside the
cavity won't be enough. Useful light is the main feature to consider to
ensure adequate light
• inside the cavity. A test mask simulates the surgeon’s head blocking light
beams to establish the usable remaining light. All tests dimensions are
defined in the standard to ensure consistent comparison across all OR
light suppliers.
• Shadow management is the
most interesting element in
terms of assessing the useful
light available for medical
staff.
• It also gives a significant clue
about light stability as surgeons
move below the light head. It is
important to minimize large
variations in illumination that
can induce eyestrain and
compromise visual acuity
during procedures.
Important considerations
in shadow management
• Several parameters have an impact on the
shadow management:
• • The illuminating surface: A good distribution of
light sources on the light head surface minimizes
the impact of obstructions.
• • Homogeneous distribution: Overlapping light
fields ensures constant homogeneity of the light
field without creating any dark areas due to
obstructions.
• • Light coming from the periphery: Larger light
heads have better shadow management as the
light coming from the periphery plays a major
role in shadow dilution. But it can be detrimental
to the useful light for narrow and deep cavities.
SUMMARY
• Surgical lights are essential to surgeons, proceduralists, and the perioperative
team in providing optimal visualization during procedures. For decades, choosing
operation room lights has been challenging, as the proper lighting is critical for
optimum patient safety and staff comfort.
• Although some ORs may opt to invest in poor-quality lighting systems, they are
also likely to bear the brunt of poor performance outcomes for the perioperative
team and clinical outcomes for patients. Inadequate lighting is a safety hazard
that can lead to injury if an object's position, shape, or speed is misjudged. It can
affect the quality and precision of work—too much or too little light strains the
eyes and may cause eye discomfort for staff.
• New-generation LED surgery lights can help solve these issues and create ideal
conditions in the OR. LED systems emitting pure white light allow surgeons to
assess and interpret the surgical cavity’s anatomical appearance accurately and
consistently. Auto intensity functionality helps surgeons better discern between a
spectrum of deep, saturated reds, precise contrast, and definition needed for
superior tonal definition. A uniform beam eliminates hot and cold spots and
reduces eye fatigue.