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(Reuters Health) – Surgery in poorer countries can become dangerous when electricity comes out, as it often does.
That's why a group of doctors who worked with a good asset called Lifebok together to design a low-cost faro for use in low- and middle-income countries, "where current breaks are small, dangerous and ubiquitous," JAMA Surgery writes.
If they can find a partner for the partnership, lights could be available as early as 2019, said the lead author, dr. Thomas Veiser, associate professor of trauma and critical care surgery at Stanford University Medical School in California.
"Our experience was that when we worked in countries where lighting was problematic, surgeons had to get out of the solution to solve the problem," Veiser said. "Most pulls a flashlight or a light on a mobile phone or reveals some other improvisation, stopgap measure."
Even when the hospital has a backup generator, it can take up to ten minutes to restore power, Veiser said. "Obviously, this is a huge security problem," he added.
Often, even when the power is on, lighting is not enough, Veiser said. "In the United States, many surgeons wear surgical headlights when they work. In the body cavity you look down the hole and want to see clearly."
Lifebok has already advanced in anesthesia and reduced infection, Veiser said. And lighting seemed to be an obvious place for the next improvement, especially with the arrival of cheaper, brighter LEDs.
The availability of a good surgical light can have a major impact on the safety of patients in poorer countries, where more than 125 million operations are carried out annually, researchers said. These are places where the current is unreliable by up to 30 percent of surgical plants due to power failure.
Veiser and his co-authors estimate that at least 24 million patients a year at risk of damage from loss of illumination during the operation.
The need is clear: 80 percent of surgeons in low- and middle-income countries reported that their current illness is a risk to patient safety, and 18 percent say they have direct knowledge about the patient injured because of poor surgical lighting, the team writes.
To develop some specifications for surgical headlights that would be useful and affordable for surgeons in poorer countries, Veiser and his colleagues first bought the eight LED lights that are currently on the market. They measured the intensity of illumination to about 16 inches from light sources and tested the maximum and minimum acceptable intensity of light in conditions when there were no other light, light and light surgical lights in the three hospitals in Ethiopia and one in the United States.
With these data and feedback from the surgeons who take part in the tests, the group has developed a set of specs for an ideal surgical light.
"It's brilliant to focus on this core that can change the security of the operation," said Dr. Rochelle Dicker, Vice President, Surgical Critical Care at the University of California, Los Angeles, and founder of the Center for Global Surgical Studies. "The most important thing is to realize that you can only operate safe operations with proper illumination and realize that millions can have life saving operations."
There are three basic needs that could make surgery much safer in poorer countries, said Dicker, who was not involved in the project. "Water so you can wash your hands, gloves we take for granted in this country, but not necessarily in those countries and lighting," she said. "When you work in the cavity of your body, it can sometimes be really difficult to see. In many places, like Tanzania and Uganda, there are masonry structures that do not allow much natural light."
Diker said that lights like one Veiser and his colleagues would design surgeons in low- and middle-income countries. "I know my colleagues in Uganda that I was 12 years old, if they saw that their fathers would have had a drink, they would be so enthusiastic that they could incorporate them."
SOURCE: https: //bit.li/2OG23ko JAMA Surgery, online November 14, 2018
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