OP E R ATING THEATR E S
of patient burns from surgical lights operating at near or maximum power when multiple light heads are focused on a small area of tissue. Recent technology and use of Light Emitting Diode (LED) surgical lighting has reduced this risk.
There are several specialties and numerous surgical procedures which demand different types of lighting in the operating theatre across both adult and paediatric fields. This is achieved through artificial light and recent developments in technology. The colour of light emitted can change the colour and appearance of skin and tissue. The function of operating lights is to reduce shadowing, not interfere with airflow patterns such as ultraclean ventilation, allow unrestricted adjustment, and illumination of the surgical site creating optimal visualisation of both small low contrast objects at various depths in incision sites and cavities during a surgical procedure.
Lighting demands must be considered for a variety of surgical specialties, including: l Orthopaedics/Trauma l Neurosurgery l Vascular l Cardiac l Microsurgery l Breast l Plastic Surgery l Ophthalmology l ENT l General Surgery l Minimal invasive/Robotic l Gynaecology
Surgical procedures require operating lights to adjust to the visual field reducing distortion and shadowing. Colour of light can affect the appearance of skin and other tissue planes, therefore effecting patient outcomes, safety concerns and efficiency. There are three predominant methods of illumination utilised in the surgical field:
Surgical Lighting Systems (SLS) l Lighted retractors (in-field focused illumination targeted to the site), sourced from a fibre optic cable, connected to a halogen or LED light source; or a cordless retractor with an integrated battery.
l Headlights (surgeons may use these as they promote increased mobility and manipulation). These can be advantageous as they reduce the need for multiple overhead light adjustments.
l Microscopes (used in microsurgery providing magnification and reverse illumination).
Surgical performance is inherently affected equally by natural and artificial environmental lighting within an operating theatre. Environmental colours and drapes
in operating rooms are often green, or blue – the opposite to red. This can sharpen, improve, and assist with chromatic changes and the surgeon’s visual acuity, making them more sensitive to different shades of red. Recent technology in surgical lighting can mitigate against the inherent environmental, operational, and visual challenges associated with surgery (Jahnavi et al 2020). There are key fundamental requirements of a surgical operating light: l Centring on the surgeon’s immediate surgical field and incision site.
l Illuminating a wide or narrow field with high-intensity light.
l Able to penetrate a cavity or under a flap.
Cardiac surgery is a high-risk area where clinical space is at a premium requiring support apparatus necessary to accommodate two medical teams working on the patient simultaneously during coronary
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artery bypass surgery (CABG) (HBN 01-01, 2013), this procedure will require one main ceiling operating light and two satellite lights if available. Most theatres only have one satellite light and use a standalone mobile light if needed. These should be positioned so that all the surgical team can have access. The cardiac theatre environment must accommodate extra machines and equipment able to facilitate modern techniques. Theatres that have traditionally been used for open surgery are now required to be multifunctional as lighting requirements have become more complex to accommodate minimally invasive surgery. Headlights are often used by many specialties, including ENT, vascular, cardiac, microsurgery, plastic, and breast surgery – optimising the surgeon’s visibility and reducing shadows. These are produced in various configurations and a variety of light sources, such as halogen and LED. They can
OCTOBER 2020
©Brandon Medical
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