Things I Wish I’d Known From the Beginning: OR Lights

One of my residents this morning thanked me for teaching her how to adjust the lights in the OR before a case. In fact, she said that since she had started this new practice that she hasn’t had to re-position the lights once while operating. There are so many minor details about the art of medicine that aren’t in books, so many things that make our lives easier…and that we wish someone had taught us earlier!

Operating Room Lights 101

Both lights should be positioned in the mid-line of the operative field – which means usually the mid-line of the table.

One of them should point straight down into the operative field. The second light should be either at the head or foot of the bed pointing into the field at an angle. If there are more than two, use them however it seems best.

Most importantly – You should position the lights BEFORE the procedure. Adjusting them after you start is always more difficult.

Operating Room Lights… Down the Historical Rabbit Hole

4500 BCE – Oil lamps

3000 BCE – Candles

1802 – Incandescent light invented by Humphrey Davy.

1850s – Operating rooms were built in the southeast corner on the top floor of hospitals to take advantage of natural sunlight. There were also four mirrors in the corners of the operating room to reflect sunlight toward the operating room table. (Wikipedia, Surgical Lighting).

1880s – Incandescent bulbs commercially available.

1920 –  The scialytic (which means “dispersing or dispelling shadows”) light invented by Professor Verain in 1920 was the first design to direct light around the head of the surgeon. This allowed operating rooms to be moved from the top floor of hospitals. (Ersek, 1972)

1930s – Fluorescent lights commercially available

1962 – First LED light developed

“The light must be sufficient in quantity, must be directed into the proper places, and must be of such a quality that the pathological conditions are recognizable. Also the light cannot produce glare, which will serve to blind the surgeon, just as the high headlights of an oncoming automobile may incapacitate an automobile operator; and it is just as dangerous.” (Beck, 1971)

There are four factors to consider in optimizing illumination (reference)

Luminance = reflected light. Too much = glare = eye strain.

Volume. This refers to the need to have light in more than one plane, which is important because we operate in three dimensions (which is why there are always two lights). This is also why surgeons wear headlights or use lighted retractors.

Shadow management. This is why the position of the lights is important!

Temperature. Was much more of an issue before LED lights.

Setting the lights to set your intention

Positioning the lights before an operation will help you see more clearly. This simple act can also become a ritual and a reminder of why you are there… to heal.