The Operating Theatre Journal July 2022

Bringing surgical lighting out of the dark ages
Current methods of surgical lighting rely on suboptimal, unergonomic
and outdated technologies that can put unnecessary strain on
surgeons. An innovative in vivo LED lighting device has been developed
to overcome these shortcomings, illuminating cavities from the inside
to avoid shadows and provide wide-angle illumination. Professor N
Gopalakrishna Iyer, Head of the Department of Head and Neck Surgery
at the National Cancer Centre Singapore and Singapore General
Hospital, discusses the collaboration between surgeons and engineers
that led to this innovation.
Surgeons need sufficient illumination to perform operations reliably,
but inadequate lighting is one of the largest shortcomings in operating
theatres. Lighting is more than just brightness, with glare and shadows
also interrupting vision, and contributing to fatigue or eye strain if not
well balanced. Vivo Surgical embarked on a mission with SingHealth
and Panasonic Lighting (Europe) to develop the KLARO in vivo lighting
system, a flexible LED light strip designed to give the best view of the
surgical cavity by illuminating it from within.
Dr Gopal, a key contributor to the project, outlined its origins:
“Current surgical lighting options are extremely limited and outdated,
yet surgeons are simply forced to work around these shortcomings. A
multidisciplinary engineering team visited our hospital, and followed
the activities of surgical teams to identify where novel solutions could
be used to overcome routine challenges. 111 areas were identified,
with surgical lighting being the most important area to improve on.”
Dr Gopal
Shining a light on the limitations of surgical lighting
“Most of my work involves cancer surgery in the oral cavity, which is
like trying to operate in a small, dark cave,” Dr Gopal commented.
“The traditional boom-mounted surgical lights hanging from the
ceiling do very little to illuminate this cavity, and often cast shadows.
Furthermore, surgeons are usually surrounded by fellow consultants,
registrars or medical students, who can block the major source of light.
Even when light is plentiful, the abundance of polished metal and other
reflective surfaces can cause constant glare, increasing eye strain and
fatigue.”
“Wearable headlights were introduced to overcome this, as they allow
the surgeon to focus the light on the site of interest, but these are often
just as problematic,” Dr Gopal added. “Usually, the primary surgeon is
the only person that wears a headlight, which means that as soon as
the surgeon changes focus, the main light source is taken away from
the rest of the team. The headlight also sits just above the eyes, which
is uncomfortable, and becomes a particular hindrance in situations
requiring surgical loupes, as having multiple pieces of equipment on
your head for long procedures can be exhausting.”
Breaking the status quo
“Optimal surgical lighting should offer sufficient – yet comfortable –
illumination, which was the idea behind the KLARO in vivo lighting
system,” Dr Gopal continued. “This device is a sterile, single-use LED
strip, offering four hours of constant illumination from inside the
surgical cavity. The concept is simple – it makes far more sense to
illuminate a cave from the inside, rather than trying to get light in
from the outside – but the design was far more complex. The engineers
identified the available technologies, and we provided first-hand
information about the limitations of surgical lighting, ensuring the
system would be tailored to address these pain points. Early on in the
design process we moved away from spotlighting toward floodlighting.
Flooding a surgical cavity with light provides wide-angle illumination
and minimises shadowing, and a flexible LED strip was the best and
most efficient hands-free approach to achieve this.”
Safety first
“Finding the optimal level of brightness to provide the best clarity
is crucial for safety and staff comfort,” Dr Gopal explained. “For
example, it can be challenging to distinguish the margins between
normal and tumour tissue when they are brightly lit, but dialling the
light down slightly can show the interface much more clearly. Similarly,
a warm, white colour light was determined to be the best choice for
distinguishing between anatomical features, as this shows the surgical
site in the most natural colour. KLARO therefore offers varying light
intensities, which allows the surgeon to choose the optimal setting for
their procedure, and the advanced LED technology maintains a safe
operating temperature of below 38 °C, making the system perfect for
in vivo use.”
Creating surgical lighting equality
“Another key feature of KLARO is its flexibility, not only in meeting the
needs of different operating procedures, but also its compatibility with
different operating theatres. The flexible strip can be used in various
surgeries – from head and neck to pelvic surgery – and, as the system is
self-contained, it can be used regardless of the resources available, and
the surgeon is able to move around freely. This device promises to equip
surgeons in any operating suite with sufficient and safe illumination,
bringing equality to surgical lighting everywhere,” Dr Gopal concluded.
The next issue copy deadline, Friday 26th July 2022
All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY
Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com
The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.com
and in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.
Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors.
All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor
at the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2022
Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.
Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD
4 THE OPERATING THEATRE JOURNAL www.otjonline.com