Minimum Specifications for a Lifebox Surgical Headlight for Resource-Constrained Settings

Improvisation of surgical light: Another way round the obstacle

The importance of surgical lighting is to illuminate the operative site on and within a patient for proper visualisation by operating theatre staff during a surgical procedure. With a good surgical illumination, a higher level of efficacy and safety can be achieved during surgery thus reducing the risk of complications. A rechargeable home LED bulb was converted into an improvised surgical lamp after removing the shade. This was mounted into the lamp holders of an old operating room lamp. This operating room lamp was plugged into an alternating current socket for power supply and recharging of the bulbs. This improvised surgical lamp provided a low temperature light source for more than 4 h. It is not however intended to replace standard operating lamps but is a viable alternative in resource challenged environments.

Exploring the Use of a Fit-for-Purpose Surgical Headlight in Sub-Saharan Africa: Mixed Methods Study

BACKGROUND

High-quality surgical lighting is often lacking in low-resource settings. Commercial surgical headlights are unavailable due to high cost and supply and maintenance challenges. We aimed to understand user needs of a surgical headlight for low-resource settings by evaluating a preselected robust but relatively inexpensive headlight and lighting conditions.

METHODS

We observed headlight use by ten surgeons in Ethiopia and six in Liberia. All surgeons completed surveys about their lighting environment and experience using headlight, and were subsequently interviewed. Twelve surgeons completed logbooks on headlight use. We distributed headlights to 48 additional surgeons, and all surgeons were surveyed for feedback.

RESULTS

In Ethiopia, five surgeons ranked operating room light quality as poor or very poor; seven delayed or cancelled operations within the last year and five described intraoperative complications due to poor lighting. In Liberia, lighting was rated as "good", however fieldnotes, and interviews noted generator fuel-rationing, and poor lighting conditions. In both countries, the headlight was considered extremely useful. Surgeons recommended nine improvements, including comfort, durability, affordability and availability of multiple rechargeable batteries. Thematic analysis identified factors influencing headlight use, specifications and feedback, and infrastructure challenges.

CONCLUSION

Lighting in surveyed operating rooms was poor. Although conditions and need for the headlights differed between Ethiopia and Liberia, headlights were considered highly useful. However, discomfort was a major limiting factor for ongoing use, and the hardest to objectively characterise for specification and engineering purposes. Specific needs for surgical headlights include comfort and durability. Refinement of a fit-for-purpose surgical headlight is ongoing.

Comparison of surgical recordings using cameras with and without laser pointer for focusing in gastrointestinal surgical field in COVID-19 pandemic: A cross-sectional study

BACKGROUND

Surgical recording has become very important for digestive surgery skill training in the COVID-19 pandemic. In addition to high quality recordings, the directions of vantage points are also important. To assist our vantage point for our camera, we frequently use a laser pointer to increase accuracy in the shooting range.

MATERIALS AND METHODS

We recorded surgery more than 2 h with a fixed top-mounted Panasonic HC-V770 camcorder and otherwise with an action-cam Sony FDR. We installed a laser Pointer TaffLED Tactical Red Dot Laser Gun Picatinny Mount Airsoft Rifle HJ 11. We compared focus field video recordings with and without laser pointer guiding. We divided them into four groups: head mounted with, head mounted without, top mounted with and top mounted without. We recorded a total of five digestive surgery cases of superficial, visceral, and deep visceral procedures for each group after adjusting the laser pointer direction to the center of the cameras' focus.

RESULTS

The laser pointer on camcorder Panasonic HC-V770 can assist recording on operation fields to prevent the field of view from being blocked by movement of an object compared to either camera without laser pointer. The head mounted Sony FDR-X3000 action-cam can easily depict surgeon's eye while recording and be controlled by the slightest movement of the surgeon's head by tracking with a red dot.

CONCLUSION

From either mounting, the laser pointer aided in focusing the surgical field of view and could increase visibility for surgical recording.

The Lifebox Surgical Headlight Project: engineering, testing, and field assessment in a resource-constrained setting

BACKGROUND

Poor surgical lighting represents a major patient safety issue in low-income countries. This study evaluated device performance and undertook field assessment of high-quality headlights in Ethiopia to identify critical attributes that might improve safety and encourage local use.

METHODS

Following an open call for submissions (December 2018 to January 2019), medical and technical (non-medical) headlights were identified for controlled specification testing on 14 prespecified parameters related to light quality/intensity, mounting and battery performance, including standardized illuminance measurements over time. The five highest-performing devices (differential illumination, colour rendering, spot size, mounting and battery duration) were distributed to eight Ethiopian surgeons working in resource-constrained facilities. Surgeons evaluated the devices in operating rooms, and in a comparative session rated each headlight in terms of performance and willingness to purchase.

RESULTS

Of 25 submissions, eight headlights (6 surgical and 2 technical) met the criteria for full specification testing. Scores ranged from 8 to 12 (of 14), with differential performance in lighting, mounting and battery domains. Only two headlights met the illuminance parameters of more than 35 000 lux during initial testing, and no headlight satisfied all minimum specifications. Of the five headlights evaluated in Ethiopia, daily operation logbooks noted variability in surgeons' opinions of lighting quality (6-92 per cent) and spot size (0-92 per cent). Qualitative interviews also yielded important feedback, including preference for easy transport. Surgeons sought high quality with price sensitivity (using out-of-pocket funds) and identified the least expensive but high-functioning device as their first choice.

CONCLUSION

No device satisfied all the predetermined specifications, and large price discrepancies were critical factors leading surgeons' choices. The favoured device is undergoing modification by the manufacturer based on design feedback so an affordable, high-quality surgical headlight crafted specifically for the needs of resource-constrained settings can be used to improve surgical safety.

A Context-Specific Design of an Electrosurgical Unit and Monopolar Handheld to Enhance Global Access to Surgical Care: A Design Approach Based on Contextual Factors

To comply with the large global need for surgery, surgical equipment that fits the challenging environment in low- and middle-income countries (LMICs) should be designed. The aim of this study is to present a context-specific design of an electrosurgical unit (ESU) and a monopolar handheld to improve global access to surgery. This paper presents both a detailed description of electrosurgery in clinical practice in LMICs and the design of an ESU generator and monopolar handheld for this specific setting. Extensive fieldwork (by means of surveys, interviews, observations, and collection of maintenance records) was done by authors RO, KO, and LH. Feedback from users working in Kenya on the first demonstrator designs was obtained, after which the designs were adapted into conceptual prototypes. These were further evaluated by surveying respondents who attended the annual meeting of the College of Surgeons of East, Central, and Southern Africa (COSECSA) in Kigali, Rwanda in December 2018. Conceptual prototypes were developed for (a) an affordable ESU that is compact and battery powered and (b) a robust reusable monopolar handheld that can be cleaned in the autoclave and by chemicals (e.g., glutaraldehyde solution). The conceptual prototypes were positively received by the 51 respondents of the survey. The findings from the field work and the feedback from users during the design phase have led to a clear understanding of the specific needs and potential solutions. The presented conceptual prototypes need to be further developed into functional prototypes, which could be implemented in Kenya and other settings for further evaluation.