RSS-Feed abonnieren

DOI: 10.1055/s-0040-1710529
Current State of Surgical Lighting
Publikationsverlauf
08. Oktober 2019
24. März 2020
Publikationsdatum:
19. Juni 2020 (online)

Abstract
Surgical performance in the operating room (OR) is supported by effective illumination, which mitigates the inherent environmental, operational, and visual challenges associated with surgery. Three critical components are essential to optimize operating light as illumination: (1) centering on the surgeon's immediate field, (2) illuminating a wide or narrow field with high-intensity light, and (3) penetrating into a cavity or under a flap. Furthermore, optimal surgical illumination reduces shadow, glare, and artifact in visualization of the surgical site. However, achieving these principles is more complex than at first glance, requiring a detailed examination of the variables that comprise surgical illumination. In brief, efficacious surgical illumination combines sufficient ambient light with the ability to apply focused light at specific operative stages and angles. But, brighter is not always merely better; rather, a nuanced approach, cognizant of the challenges inherent in the OR theater, can provide for a thoughtful exploration of how surgical illumination can be utilized to the best of its ability, ensuring a safe and smooth surgery for all.
-
References
- 1 Okoro SA. . Who needs the surgical headlight? PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17328649 . Accessed March 14, 2019
- 2 Knulst AJ, Mooijweer R, Jansen FW, Stassen LPS, Dankelman J. Indicating shortcomings in surgical lighting systems. Minim Invasive Ther Allied Technol 2011; 20 (05) 267-275
- 3 Esser AC, Koshy JG, Randle HW. . Ergonomics in office-based surgery: a survey-guided observational study. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17958581 . Accessed February 19, 2019
- 4 Stucky CH, Cromwell KD, Voss RK, et al. Surgeon symptoms, strain, and selections: Systematic review and meta-analysis of surgical ergonomics. Ann Med Surg (Lond) 2018;27:1–8
- 5 Schweitzer D, Klaber I, Fischman D, Wozniak A, Botello E, Amenábar PP. Surgical light handles: a source of contamination in the surgical field. Acta Orthop Traumatol Turc 2015; 49 (04) 421-425
- 6 Simmons RM, Willey SC, Fine RN. , et al. Nipple sparing mastectomy and the advent of an enabling surgical illumination and visualization system clinical experience survey of thought leaders in breast surgery; 2013 . Available at: https://pdfs.semanticscholar.org/5328/0ef0882a0d6805d038b43cc842ef39622090.pdf . Accessed February 19, 2019
- 7 Hensman CE. . Total radiated power, infrared output, and heat generation by cold light sources at the distal end of endoscopes and fiber optic bundle of light ca. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9543524 . Accessed February 19, 2019
- 8 ECRI Press. ECRI Institute announces new initiative to extinguish surgical fires. ECRI Institute; 2018 . Available at: https://www.ecri.org/press/ecri-institute-announces-new-initiative-to-extinguish-surgical-fires . Accessed March 14, 2019
- 9 Sandhu HE. . No smoke without fire—simple recommendations to avoid arthroscopic burns. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12424045 . Accessed February 19, 2019
- 10 Hindle AK, Brody F, Hopkins V, Rosales G, Gonzalez F, Schwartz A. . Thermal injury secondary to laparoscopic fiber-optic cables. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19030930 . Accessed February 19, 2019
- 11 Smith LP, Roy S. . Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18439950 . Accessed February 19, 2019
- 12 Spradling KE. . Evaluation of ignition and burn risk associated with contemporary fiberoptic and distal sensor endoscopic technology. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25809547 . Accessed February 19, 2019
- 13 Lau YJ, Dao Q. . Cutaneous burns from a fiberoptic cable tip during arthroscopy of the knee. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18514527 . Accessed February 19, 2019
- 14 Top 10 technology hazards. High-priority risks and what to do about them. Health Devices 2009; 38 (11) 364-373
- 15 de Armendi AJ, Shukry M, Strong P, Cure JA. Headlight with fiber-optic xenon light source may cause harm to patients. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19944902 . Accessed February 19, 2019
- 16 Bourke DL, Yee K, Mark L. . Severe burn caused by an operating room light. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8342802 . Accessed February 19, 2019
- 17 Itagaki TE. . Skin burn caused by operating light during a long operation after photodynamic therapy. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12657866 . Accessed February 19, 2019
- 18 Rao VK, Dibbell DG. . Accidental hand burns caused by operating room lights. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/3351228 . Accessed February 19, 2019
- 19 Schutt CA, Redding B, Cao H, Michaelides E. The illumination characteristics of operative microscopes. Am J Otolaryngol 2015; 36 (03) 356-360
- 20 Choudhry IK, Kyriakedes J, Foad MB. . Iatrogenic burn caused by an operating microscope: case report. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23337461 . Accessed February 19, 2019
- 21 Al-Qattan MM, Clarke HM. . A burn caused by the operating microscope light during brachial plexus reconstruction. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7822907 . Accessed February 19, 2019
- 22 Latuska RF, Carlson ML, Neff BA, Driscoll CL, Wanna GB, Haynes DS. , et al. Auricular burns associated with operating microscope use during otologic surgery. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24270729 . Accessed February 19, 2019
- 23 Boldrey EE, Ho BT, Griffith RD. . Retinal burns occurring at cataract extraction. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/6514294 . Accessed February 19, 2019
- 24 Japan Council for Quality Health Care. Burns caused by the tip of a light source cable during surgery. Project to collect medical near-miss/adverse event information; 2012 . Available at: http://www.med-safe.jp/pdf/No.70_MedicalSafetyInformation.pdf . Accessed February 19, 2019
- 25 ECRI Institute. Hazard report. Overlap of surgical lighthead beams may present burn risk. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20853770 . Accessed February 19, 2019
- 26 Borie FE. . Risk management for surgical energy-driven devices used in the operating room. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29289460 . Accessed February 19, 2019
- 27 Smith LP, Roy S. . Operating room fires in otolaryngology: risk factors and prevention. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20392535 . Accessed February 19, 2019
- 28 Seifert PC, Peterson E, Graham K. . Crisis management of fire in the OR. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25645041 . Accessed February 19, 2019
- 29 AlQahtani SM, Alzahrani MM, Harvey EJ. . Prevalence of musculoskeletal disorders among orthopedic trauma surgeons: an OTA survey. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26812408 . Accessed February 19, 2019
- 30 Knudsen ML, Ludewig PM, Braman JP. . Musculoskeletal pain in resident orthopaedic surgeons: results of a novel survey. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25328481 . Accessed February 19, 2019
- 31 Ruitenburg MM, Frings-Dresen MH, Sluiter JK. . Physical job demands and related health complaints among surgeons. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22456979 . Accessed February 19, 2019
- 32 Dianat I, Bazazan A, Souraki Azad MA, Salimi SS. . Work-related physical, psychosocial and individual factors associated with musculoskeletal symptoms among surgeons: implications for ergonomic interventions. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29122182 . Accessed February 19, 2019
- 33 Tzeng YS, Chen SG, Chen TM. . Herniation of the cervical disk in plastic surgeons. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23154341 . Accessed February 19, 2019
- 34 Sahni D, James KB, Hipp J, Holloway S, Marco RAW. Is there an increased incidence of cervical degenerative disease in surgeons who use loupes and a headlight?. J Spine 2015; 4 (05) 256
- 35 Fisher SM, Teven CM, Song DH. . Ergonomics in the operating room: the cervicospinal health of today's surgeons. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30511995 . Accessed February 19, 2019
- 36 Epstein S, Sparer EH, Tran BN. , et al. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg 2018; 153 (02) e174947-e174947
- 37 Rodigari AE. . Identification of risk factors for fatigue and pain when performing surgical interventions. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23477110 . Accessed February 19, 2019
- 38 Lee JY, Lantz AG, McDougall EM. , et al. Evaluation of potential distractors in the urology operating room. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23691940 . Accessed February 19, 2019
- 39 Pereira BM, Pereira AM, Correia Cdos S, Marttos Jr AC, Fiorelli RK, Fraga GP. Interruptions and distractions in the trauma operating room: understanding the threat of human error. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22124638 . Accessed February 19, 2019
- 40 Persoon MC, Broos HJ, Witjes JA, Hendrikx AJ, Scherpbier AJ. The effect of distractions in the operating room during endourological procedures. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20734086 . Accessed February 19, 2019
- 41 Yoong WE. . Interruptions and distractions in the gynaecological operating theatre: irritating or dangerous? PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25672986 . Accessed February 19, 2019
- 42 Sevdalis NE. . Impact of intraoperative distractions on patient safety: a prospective descriptive study using validated instruments. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24240670 . Accessed February 19, 2019
- 43 Mark G, Gudith D, Klocke U. . The cost of interrupted work. Paper presented at: 26th Annual CHI Conference on Human Factors in Computing Systems—CHI '08: Florence, Italy; 2008 . Available at: http://dx.doi.org/10.1145/1357054.1357072
- 44 ACOS. Statement on Distractions in the Operating Room. American College of Surgeons. Available at: https://www.facs.org/about-acs/statements/89-distractions . Accessed March 14, 2019
- 45 Antoniadis SE. . Identification and interference of intraoperative distractions and interruptions in operating rooms. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24405613 . Accessed February 19, 2019
- 46 Avidan AE. . Cell phone calls in the operating theater and staff distractions: an observational study. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28072614 . Accessed February 19, 2019
- 47 Mentis HM, Chellali A, Manser K, Cao CGL, Schwaitzberg SD. A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Surg Endosc 2016; 30 (05) 1713-1724
- 48 Murji A, Luketic L, Sobel ML, Kulasegaram KM, Leyland N, Posner G. Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety. Surg Endosc 2016; 30 (10) 4499-4504
- 49 Sami AE. . Real-time observations of stressful events in the operating room. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22754439 . Accessed February 19, 2019
- 50 Wheelock AE. . The impact of operating room distractions on stress, workload, and teamwork. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26291954 . Accessed February 19, 2019
- 51 Yang CE. . Impaired laparoscopic performance of novice surgeons due to phone call distraction: a single-centre, prospective study. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28597285 . Accessed February 19, 2019
- 52 Azizi JE. . Uphill grime: process improvement in surgical instrument cleaning. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22840504 . Accessed February 12, 2019
- 53 Kumar N, Lothlikar V, Souza BD, Rani U, Swapna BV. Cost analysis of re-sterilization procedure of re-usable devices in a hospital. J Young Pharm 2018; 10 (01) 109-112
- 54 Southworth PM. . Infections and exposures: reported incidents associated with unsuccessful decontamination of reusable surgical instruments. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25287950 . Accessed February 12, 2019
- 55 Srejic E. . Reusables, disposables each play a role in preventing cross-contamination. Infection control today; 2016 . Available at: https://www.infectioncontroltoday.com/personal-protective-equipment/reusables-disposables-each-play-role-preventing-cross-contamination . Accessed February 10, 2019
- 56 Center for Devices. Radiological health. mandatory reporting requirements: manufacturers, importers and device user facilities—manufacturer and user facility device experience database—(MAUDE). Available at: https://www.fda.gov/medicaldevices/deviceregulationandguidance/postmarketrequirements/reportingadverseevents/ucm127891.htm . Accessed March 14, 2019
- 57 Tosh PK, Disbot M, Duffy JM. , et al. Outbreak of Pseudomonas aeruginosa surgical site infections after arthroscopic procedures: Texas; 2009 . PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22080656 . Accessed February 19, 2019
- 58 Vijayaraghavan RE. . Hospital outbreak of atypical mycobacterial infection of port sites after laparoscopic surgery. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17046106 . Accessed February 13, 2019
- 59 Obasi CE. . Contamination of equipment in emergency settings: an exploratory study with a targeted automated intervention. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19642994 . Accessed February 13, 2019
- 60 Litrico SE. . Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26325248 . Accessed February 12, 2019
- 61 Mont MA, Johnson AJ, Issa K. , et al. Single-use instrumentation, cutting blocks, and trials decrease contamination during total knee arthroplasty: a prospective comparison of navigated. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23359398 . Accessed February 12, 2019
- 62 Alvarado CJ, Anderson AG, Maki DG. . Microbiologic assessment of disposable sterile endoscopic sheaths to replace high-level disinfection in reprocessing: a prospective clinical trial. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19482219 . Accessed February 13, 2019
- 63 Frosh AE. . Iatrogenic vCJD from surgical instruments. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11431283 . Accessed February 13, 2019
- 64 LaBove G, Davison SP. Cost analysis of an office-based surgical suite. Plast Reconstr Surg Glob Open 2016;4(7):e803
- 65 Isaacson D, Ahmad T, Metzler I. , et al. Defining the costs of reusable flexible ureteroscope reprocessing using time-driven activity-based costing. J Endourol 2017; 31 (10) 1026-1031
- 66 Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual 2015; 37 (05) 277-286
- 67 Stockert EW, Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg 2014; 219 (04) 646-655
- 68 Mager R, Kurosch M, Höfner T, Frees S, Haferkamp A, Neisius A. Clinical outcomes and costs of reusable and single-use flexible ureterorenoscopes: a prospective cohort study. Urolithiasis 2018; 46 (06) 587-593
- 69 Yang R, Ng S, Nichol M, Laine L. A cost and performance evaluation of disposable and reusable biopsy forceps in GI endoscopy. Gastrointest Endosc 2000; 51 (03) 266-270
- 70 Aïssou ME. . Cost analysis comparing single-use (Ambu® aScopeTM) and conventional reusable fiberoptic flexible scopes for difficult tracheal intubation [in French]. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23561716 . Accessed March 7, 2019
- 71 Yu YR, Abbas PI, Smith CM. , et al. Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy. J Pediatr Surg 2016; 51 (12) 1962-1966
- 72 Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg 2018; 153 (04) e176233
- 73 Girotto JA, Koltz PF, Drugas G. . Optimizing your operating room: or, why large, traditional hospitals don't work. PubMed—NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20478418/ . Accessed March 14, 2019