An operation theatre is a room in a hospital, equipped for the performance of surgical operations, with operation theater tables and lights being its elemental parts. Operation theatre tables and lights in any hospital, should provide comfort to doctors and nurses while treating the patient. In any operation, the design and quality of operation theatre tables and lights, play a very important role in making the patients comfortable during their treatment. Surgery demands new operating tables, which can carry plenty of weight, are highly versatile, and can fit seamlessly into the logistics chain.

Market dynamics-OT tables

The OT tables market, at Rs. 52 crore, with sales of 1400 units in 2009, has seen a unit-wise growth of 27 percent, against 1,100 units sold in 2008.

The imported segment continues to dominate, at an 81 percent market share, with sales of 600 units at Rs. 42 crore. It is expected to witness a 30 percent increase in 2010. The popular brands are Bet Medical, Maquet, and Mediland (marketed by Janak). This year, apart from its regular sales, Bet Medical received a 156 unit order from the Indian Army, for its brand, Trident. Other brands with some presence in this segment are Steris, Trumph, and Takeuchi. The unit prices range from Rs. 450,000 to Rs. 550,000 for the mid-end range; and Rs. 600,000 to Rs. 900,000 for the high-end tables-more popular with the corporate hospitals and nursing homes.

The indigenous tables, albeit at a higher sales level (800 units), have a lower value-wise contribution of 19 percent (Rs. 10 crore). This segment is catered to by Cognate, Staan, Janak Healthcare, Palakkad Surgical (strong in South India, especially Kerala, now in a marketing tie-up with Janak), Magnatek, SS Technomed (stronger in the northern states of India), and Surgident. The unit prices range from Rs. 75,000 to Rs. 350,000.

Major players

Bet Medical offers highly rugged and proven OT tables, for applications in orthopedics, urology, gynecology, cardiothoracic, and general surgery. Its Not 5600 series of OT tables feature 360º rotational and detachable traction arms. Its Dr. Max 7000S offers features like 350 mm longitudinal sliding, auto-leveling, and 520 mm low-height profile.

Maquet provides a wide range of OT tables for shoulder procedures, spinal surgery, cervical spine treatment, neurosurgery, cardiovascular surgery, thorasic surgery, laparoscopic surgery, pediatric surgery, and treatment of lower extremities. In its operating table systems range it offers Alphamaquet and Magnus OT tables. It also offers Alpha-classic, Betastar, Alphastar, Alphamaxx, and Orthostar in its mobile operating tables range.

Janak Healthcare, representing Mediland, offers a wide range of high-end OT tables, including Amax 9000 Plus, Smart P2000, C600 SND, Emax 300, and C200. Its Amax 9000 Plus features a multi-purpose table-top with reverse orientation, for use in cardiac, urological, and almost all others surgical procedures. Its C600 SND is a universal low-height electrohydraulic OT table, with sliding table-top.

Magnatek added a new range of imported OT tables for neurosurgery, orthopedics, and cardiac surgery. It has also introduced specialized import substitute tables for bariatric, pediatric, and gastroenterology procedures. Its OT table product range includes, Obesomatic, Eiffel, Magnum Multistar, Cardiomatic, Laparostar, Babystar, Float-O-Matic, Urostar, Neurostar, and Olympian 2000. Its Obesomatic OT table is a specialized automatic table for surgeries on obese patients, which can hold a patient load of 350 kgs. Eiffel is a versatile imported table for multiple procedure applications, with various world class features.

Driven by technology

Driven by the demographic trend toward an ageing population, and technological advances that have resulted in strong growth of surgical procedures across the globe, the world market for operating tables is projected to reach US$ 762.6 million, by the year 2015.

Various types of operating tables are available in the market, which are capable of being used for specialized procedures for heavy-duty purposes, in addition to catering to the basic requirements. Advancement in surgical procedures, imaging methods, and a shift in the procedures, from invasive to non-invasive (which demand uniquely positioned patients), is driving the technological developments in the operating tables market.

Operating tables are primarily used to keep the patient in the best possible position for the surgeon to conduct the surgical procedure and, if necessary, enable any adjustments required during the procedure. Obsolescence of existing equipment continues to remain a driving factor for the operating tables market. On the negative side, measures taken for cost-reduction, and extended replacement cycles of operating tables, are expected to limit market growth. However, increase in cost-effective surgical techniques, renovation of existing surgical suites, and establishment of outpatient surgical centers are expected to minimize these effects.

OT tables can be of fixed, or mobile bases. They are equipped with the latest electro-hydraulic and electro-mechanical technologies. Specialized attachments for ease-of-patient-positioning, are a must-have for operation theater table. Operating tables, which have evolved as the fully multi-function systems, have electric motor drive and power assisted brakes with all the control functions. Low height helps in reducing physical stress in long duration procedures on surgeons, as they can operate while sitting; and with the option of table top slide, surgeries can be done with greater precision and comfort. Infrared controls, foot switch, cable remote control, and control panel, are the special features, by help of which all the operations of the table can be done from a distance, without touching the sterile area.

Market dynamics-OT lights

The OT lights market has observed a modest growth of 8 percent from 1300 units sold in 2008, to an estimated 1405 units sold in 2009.

With sales of 910 units, mid and low-end OT lights, together, dominated the market with a unit-wise contribution of 65 percent. Being a competitively priced product, mid and low-end OT lights are popular with smaller hospitals and nursing homes.

The balance 495 units (35 percent) were accounted for by high-end OT lights. Depending on the application and requirements, high-end OT lights may be of single-dome or multiple domes. While 100 units of high-end single-dome OT lights were sold, multiple domes registered a sale of 395 units. These offer features like HD camera compatibility, and multimedia facility.

LED OT lights are the latest entrants, and are triggering growth with significant adoption from discerning hospitals.

Maquet and Philips dominate the OT lights market. Other players include, Allied Medical, Bet Medical, Janak, Magnatek, Mindray, Trivitron, Spark Meditech, and SNG.

Major players

Maquet offers PRX, X10, AXL, Powerled, HLED, Bluline, HLX, and Lucea range of halogen and LED surgical and examination lights. It also offers Alphaport and Modutec range of fixed, motorized, and non-motorized pendants for OR and ICU.

Philips offers Phililux range of ceiling-mounted, mobile, and wall-mounted OT lights. These OT lights feature high intensities up to 160,000 lux, using cold mirror technology and laminar flow compatibility, producing cold, brilliant light.

Bet Medical provides Dr. Lite 2066 series from Trident Medical Corporation, Japan-offering single bulb technology, with intensity from 140,000 lux to 160,000 lux, per dome.

Janak Healthcare markets Mediled and Slimled OT lights, featur white phosphor-based LED technology, with variable and fixed-focus pattern size. It also offers Medilux ML600, Estella 1, Estella 7, and Midmark 355 halogen OT lights.

Magnatek offers Magnaled range of mobile and ceiling mounted LED lights, and Magnapax range of halogen lights.

Mindray offers HyLite 6500/6700 OT lights, featuring cavity-lighting capability and shadow-free light, with a maximum of 150,000 lux. Its HyLed 9500/9700 range offers long service time, up to 40,000 hours.

Spark Meditech offers Beam series of OT lights for endoscopy usage. In its minor OT lights range, it offers Halux 50 series, Iris series, ISIS Duo, Sturn series, and Xerus series. Its major LED shadow-less OT lights range includes, Starled 1, Starled 3 EVO, and OT Starled.

SNG offers Ledilux range of LED based lights, and Medilux range of halogen OT lights.

High-end illumination

Operating theatre lights deliver performance to the operating room through a highly-refined and technologically advanced lighting system. With a clear visibility of the operating area, the efficiency of a surgeon can improve greatly, and stress can reduce multi-fold. Advanced OT lights have excellent shadow-less effect with focusing mobile operation. They completely meet the laminar flow purification in the operating room, with a high efficiency endothermal system to control the temperature. The latest OT lights usually have a multi-rotated mirror reflector system, which forms thousands of reflections, and may give a focusing beam of high illumination.

Most surgical lights generally fall in the range of 80,000 to 180,000 lux. The central illumination should be in the range of 40,000 lux to 160,000 lux. The color temperature of most surgical lights is around 4000 to 4500 K. 90-95 is the typical color rendering index (CRI) range for these lights. Another crucial factor is the cool operation of the surgical lights, as lights that give off heat may cause a lot of discomfort to the surgical team. The lights should essentially be shadow-free, as the shadows cast on the surgical site by the position and movement of the surgical team, as well as the medical equipment used in operation theaters, causes a lot of interference in the surgical procedure. Flexible, maneuverable, and light-weight surgical lights are preferred to deliver light wherever needed. OT lights should be protected with a UPS power back-up, to ensure uninterrupted light supply.

The popularity of LED lighting units is inevitably increasing because LED light is infrared-free and cool-creating good work conditions for surgeons, and minimizing the danger of tissue dehydration. In addition, the nearly limitless service life of LEDs lowers maintenance costs, and ensures safe, reliable work.

LED fixtures, in comparison, are twice as efficient as fluorescents at converting electricity to light, and hence generate very little heat. In addition to improved energy efficiency, LED fixtures are nearly maintenance free, and provide high quality of light. They are also dimmable, contain no mercury, and tolerate frequent on/off switching without degrading their lifespan.

On market trends

2009 was a very exciting growth period for the healthcare industry. We saw large expansion plans from major hospitals, as well as new hospitals rising up to meet the growing healthcare industry demand. 2010 is continuing to reflect these accelerated growth plans, and we are very positive about the market growth, both for indigenous, and imported products.

On various segments

With surgeons and surgeries becoming more specialized, the need for precision has increased, leading to a rising awareness and demand in customized tables for specialties like neurosurgery, orthopedics, pediatrics, bariatrics, and so forth. With rising quality consciousness, and increasing demands for imported tables and high-end indigenous tables, the overall market for OT tables is on the rise. The high-end tables segment constitutes 70 percent in terms of value.

On driving factors

Quality accreditations, after-sales service, installation base, and the ability to customize products, are some of the key driving factors. We foresee a 50 percent accelerated growth rate for the next three years.

On emerging trends and new technologies

Smart integrated OTs, which facilitate better imaging and use of robotics, are the key global trends. With minimally invasive surgery gaining popularity, automated controls and accessibility, as well as quality of imaging, have led to the emergence of demand for automated tables with precise movements, and high luminescent, color-changing LED lights.

On challenges and opportunities

One of the key challenges faced by Indian manufacturers is the perception of the quality of indigenously manufactured tables and lights, even though high-end indigenous tables and lights are available at a fraction of the cost of their imported counterparts. However, this perception is changing, and customers are looking forward to customizable, high-quality Indian tables, which will result in substantial cost savings.

On company's activities

Magnatek has an all-India network of channel partners, located in all major cities. We have added a new range of imported OT tables for neurosurgery, general surgery, and specializations like orthopedics, and cardiac surgery. We also have introduced specialized import substitute tables for bariatric, pediatric, and gastroenterology procedures. A new range of affordable imported LED OT lights, with eight color change options, have also been successfully launched.

On market trends

Starting from 2009, Mindray Medical has provided state-of-the-art, total OR solutions-including pendants/beams, surgical lights (halogen and LED), operation tables, anesthesia machines, patient monitors, defibrillators, and portable color dopplers-to the fast-growing Indian market.

Even though Mindray Medical has only marketed OT tables and lights for less than one year, we have already made breakthroughs in some of the most renowned hospitals, such as Fortis, Apollo, and Global hospitals.

On driving factors

Undoubtedly, the expansion of new hospitals is the main factor driving the OT market's rapid pace. Mindray Medical has been involved in many new hospital projects, providing an end-to-end solution ranging from designing, to installation and commissioning. We expect to be among the top two players in the OT tables and lights segment, within the coming three years.

On emerging trends and new technologies

The emerging trend in the OT table and light market is that it is being combined with ceiling supply units (pendant/beam). The supplier who offers the total OR solution has the advantage when competing for projects, since it's often difficult and complex to unite products coming from separate companies.

On challenges and opportunities

Challenges are always accompanied by opportunities. Still, it is valid to say that India is a vast and very price-sensitive market, a type of Red Sea for every industry. As the laminar flow concept has been quite popular in modern hospitals, people have realized that there are complicated relationships among the basic medical equipment, scientific workflow, and the laminar flow. Normally, in an operating room, there is a ceiling supply unit, surgical lights, an operation table, an anesthesia machine, a patient monitor, a defibrillator, and a color doppler, however they may all be belonging to different companies. Now, companies offering total OR solutions, are providing for the concept-of all of the medical equipment and modern workflow being completely compatible, and integrative-to become a significant reality.