The Operating Theatre Journal July 2022

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Bringing surgical lighting out of the dark agesCurrent methods of surgical lighting rely on suboptimal, unergonomicand outdated technologies that can put unnecessary strain onsurgeons. An innovative in vivo LED lighting device has been developedto overcome these shortcomings, illuminating cavities from the insideto avoid shadows and provide wide-angle illumination. Professor NGopalakrishna Iyer, Head of the Department of Head and Neck Surgeryat the National Cancer Centre Singapore and Singapore GeneralHospital, discusses the collaboration between surgeons and engineersthat led to this innovation.Surgeons need sufficient illumination to perform operations reliably,but inadequate lighting is one of the largest shortcomings in operatingtheatres. Lighting is more than just brightness, with glare and shadowsalso interrupting vision, and contributing to fatigue or eye strain if notwell balanced. Vivo Surgical embarked on a mission with SingHealthand Panasonic Lighting (Europe) to develop the KLARO in vivo lightingsystem, a flexible LED light strip designed to give the best view of thesurgical 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a key contributor to the project, outlined its origins:“Current surgical lighting options are extremely limited and outdated,yet surgeons are simply forced to work around these shortcomings. Amultidisciplinary engineering team visited our hospital, and followedthe activities of surgical teams to identify where novel solutions couldbe used to overcome routine challenges. 111 areas were identified,with surgical lighting being the most important area to improve on.”Dr GopalShining a light on the limitations of surgical lighting“Most of my work involves cancer surgery in the oral cavity, which islike trying to operate in a small, dark cave,” Dr Gopal commented.“The traditional boom-mounted surgical lights hanging from theceiling 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 otherreflective surfaces can cause constant glare, increasing eye strain andfatigue.”“Wearable headlights were introduced to overcome this, as they allowthe surgeon to focus the light on the site of interest, but these are oftenjust as problematic,” Dr Gopal added. “Usually, the primary surgeon isthe only person that wears a headlight, which means that as soon asthe surgeon changes focus, the main light source is taken away fromthe rest of the team. The headlight also sits just above the eyes, whichis uncomfortable, and becomes a particular hindrance in situationsrequiring surgical loupes, as having multiple pieces of equipment onyour 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 lightingsystem,” Dr Gopal continued. “This device is a sterile, single-use LEDstrip, offering four hours of constant illumination from inside thesurgical cavity. The concept is simple – it makes far more sense toilluminate a cave from the inside, rather than trying to get light infrom the outside – but the design was far more complex. The engineersidentified the available technologies, and we provided first-handinformation about the limitations of surgical lighting, ensuring thesystem would be tailored to address these pain points. Early on in thedesign process we moved away from spotlighting toward floodlighting.Flooding a surgical cavity with light provides wide-angle illuminationand minimises shadowing, and a flexible LED strip was the best andmost efficient hands-free approach to achieve this.”Safety first“Finding the optimal level of brightness to provide the best clarityis crucial for safety and staff comfort,” Dr Gopal explained. “Forexample, it can be challenging to distinguish the margins betweennormal and tumour tissue when they are brightly lit, but dialling thelight down slightly can show the interface much more clearly. Similarly,a warm, white colour light was determined to be the best choice fordistinguishing between anatomical features, as this shows the surgicalsite in the most natural colour. KLARO therefore offers varying lightintensities, which allows the surgeon to choose the optimal setting fortheir procedure, and the advanced LED technology maintains a safeoperating temperature of below 38 °C, making the system perfect forin vivo use.”Creating surgical lighting equality“Another key feature of KLARO is its flexibility, not only in meeting theneeds of different operating procedures, but also its compatibility withdifferent operating theatres. The flexible strip can be used in varioussurgeries – from head and neck to pelvic surgery – and, as the system isself-contained, it can be used regardless of the resources available, andthe surgeon is able to move around freely. This device promises to equipsurgeons 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 2022All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YYTel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.comThe Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.comand 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 Editorat the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2022Operating 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 1QD4 THE OPERATING THEATRE JOURNAL www.otjonline.com
Operating Department Practitioner – New ZealandSalary from 40,000 pounds per yearFree flightsAssistance with accommodationPick up at airport and assistance and resettlement on arrivalDo you want to work at the largest tertiary centre in the South Island?You will get work-life balance and with adventure never far away from your doorstep, if you are considering a move, this could well be your bestone yet! The Canterbury region provides pristine beaches, gorgeous mountain backdrops and many opportunities for exciting activities, shopping,and attractions. Want to go snow skiing, fishing, tramping, bungy jumping or for a day out shopping and eating? You can achieve all your dreamsin Canterbury!This is your chance to join a health system that truly cares. Our client is a world leader in the delivery of integrated healthcare, and right now theyhave the opportunity for you!As a highly skilled Anaesthetic Technician, you will be eager to play a key role in continuing their drive of constant improvement, provide exceptionalcare and delivery of service, and enjoy a varied and fast paced environment.As the largest tertiary centre in the South Island their service also encompasses several other sites across Christchurch and houses state of theart equipment while offering a varied case mix.The Role: Where you fit inIn this role, you will be responsible for:• Providing professional, technical, and clinical assistance to Anaesthetists.• Preparing equipment within operating theatres or areas where anesthesia is provided.• Anticipate problems and exceptional patient care.• Mentoring trainee Anaesthetic Technicians.You must:• Have a recognised qualification within New Zealand or international equivalent.• Have registration with the Medical Sciences Council (or eligibility to obtain) and an Annual Practising Certificate• Having a minimum of 2 years’ experience is preferable but not essential.• Have strong interpersonal skills.• Be motivated to embrace challenges and change as well as being able to work in challenging environments.We can provide the successful applicants with:• Assistance with registration, immigration, and relocation processes• Reimbursement of registration fees with MSCNZ and APC• Contribution towards relocation costs• Payment for accommodation and flightsFor interviews or for any questions you may have regarding this fantastic opportunity please contact info@accent.net.nzFree call from the UK 0808 23 444 68Or WhatsApp 006421 403143Find out more 02921 680068 • e-mail admin@lawrand.com Issue 382 July 2022 5
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The Operating Theatre Journal July 2022

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