Attractive Opportunities

Equipment is the soul of every operating room. Better outcomes in surgical procedures require better supporting technologies and equipment. They can add joy to a surgery by reducing stress and making surgeries more precise, convenient, and time saving. Advances in technology in the field of surgery, along with the shift from open surgeries to minimal invasive procedures have increased the need for more flexible operating rooms (OR) with advanced equipment such as operating tables, surgical booms, and surgical lights. Operating table and light source are the centerpiece of every operating theatre.

Hospitals are constantly looking for ways to be safe but also to be more efficient, so that they can manage more cases in one day. Seamless functionality, comfort, access, and safety are the first needs that come to mind. Manufacturers are thus focusing on providing easy-to-use and reliable equipment. In time, various special surgical disciplines have developed from so-called general surgery, so that special operating equipment have been designed and produced to suit these requirements. Key players are aiming for product innovations and new launches to cope with growing needs.

Together with increasing number of OR in the hospitals the demand for advanced equipment is driving the growth of the global OR equipment market at a significant rate. Growing funds and investments by various government bodies and private investors are also contributing to the growth of the market. For instance, in India, the healthcare infrastructure is set to rise to make the country a global healthcare hub. The country is expected to spend over 1,340,000 crore by 2024 to strengthen its medical infrastructure. Various hospitals including AIIMS, Safdarjung, and Fortis will be expanding their facilities in the coming years. AIIMS Bhubaneswar has set a target to add 30 modular OTs with latest technologies within the next one year.

OT Tables
Operating tables are a staple requirement for a surgery or medical procedure. Having been present since the 19th century, operating tables have evolved a lot with technology and with the evolution there have been different types of operating tables developed for different kinds of surgeries. However, one crucial aspect of operating tables that does stay the same in every case is to provide the patient immense comfort and be easy for the doctor to use according to the surgery.

It is tempting, in an era when watches can connect to the Internet, to put an unlimited number of gadgets and gizmos on surgical tables. They can become so loaded with extras, however, that a surgical table’s primary function is overlooked. As a general rule of thumb, it is best to keep surgical tables as simple as possible, so as to avoid mistakes in the OR due to insufficient training or knowledge about the table.

Indian Market Dynamics
In 2016, the Indian OT tables market is estimated at 400 crore with sales at 4000 units. The indigenous segment with 3200 units constitutes 80 percent of the total market, in volume terms. This is a major change in trend, with indigenous brands offering excellent quality and gaining market share. The Indian segment is dominated by Magnatek Enterprises, Staan, and Palakkad Surgical. Surgdent, Cognate, and Midmark (Janak) are aggressive players.

The market for imported OT tables in 2016 is estimated at 800 tables, estimated worth 100 crore. This market is catered to by BenQ (Bet Medical), Maquet, Eiffel (Magnatek), Mediland, Steris (including Eschmann), Scharer, Mindray, Stryker, Trumph, Takeuchi, Mezhuo, and Schmitz. Famed, Martin, OPT, and Haliday also have a presence in this segment.

The market is growing at an accelerated rate with focus on specialized healthcare, with larger expansions by corporate hospitals sensing a huge potential in untapped Indian masses and the government investing in the healthcare sector by opening a large number of institutes across the country and initiating better healthcare schemes. The country is expected to spend over 1,340,000 crore by 2024 to strengthen its medical infrastructure. Various hospitals including AIIMS, Safdarjung, and Fortis are expanding their facilities. AIIMS Bhubaneswar has set a target to add 30 modular OTs with latest technologies within the next one year.

Since the last couple of years, in response to the huge demand from all over the country, a large number of Indian and Chinese brands have almost sprung up. At Medicall 2017 held recently in Chennai, 30–35 new OT tables vendors had participated with their respective product range, making the competition fierce. Vendors that have the capability to develop highly specialized and technologically advanced products are expected to gain a competitive edge over their peers.

Global Market
The global operating tables market is projected to grow at a steady CAGR of 3.82 percent from 2017 to 2020, predicts Research and Markets, driven by the robust increase in global volume of surgeries performed against the backdrop of a growing disease burden and the popularity of surgical care and intervention as the preferred treatment mode guided by developments in minimally invasive surgeries.

Moreover, increasing number of ambulatory surgical centers and the rising demand for hybrid OR will boost the market growth. Technological advancements in the field and high adoption rate for operating tables with new technology will also drive the global market. Growing in prominence are electrohydraulic tables with multiple patient-positioning options that increase clinical versatility, enable integration of imaging equipment, and ensure compatibility with computer-video based surgical practices. However, some of the important factors which restrain the global market for operating tables include high cost involved and lack of skilled medical professionals for proper handling of operating tables.

North America dominates the market owing to better infrastructure, technological advancement, improved healthcare facilities, and high demand of operating tables in the region. Asia-Pacific is expected to emerge as the fastest growing market, led by rising standard of living, improving healthcare infrastructure, rising healthcare awareness resulting in demand for high-quality medical services, spurt in medical tourism, and increased hospital investments in patient-handling infrastructure.

Technology Trends
Technological advancements have moved the surgical table way beyond glorified gurney into a cross between the space shuttle and a carnival ride. The need for versatility, articulation, safety, efficiency, flexibility, and reliability is reflected in models that can literally move up, down, and all round, take pictures in the process, and all the while support the considerable weight of the expanding population.

Simplicity. There is always a risk of creating tables that are too complex since surgeons need to be able to practice medicine and take care of patients without having to be thrust into the role of an engineer just to be able to use the table. Manufacturers are focusing on a small group of tables that do the very best job, rather than have one table that attempts to supply all needs but does not do any of them well. They intend to keep it simple with a safe, strong, reliable, durable table that is also very flexible. Accordingly, easy access and ease of use are key drivers.

Bariatric tables. These days, hospitals of all sizes have to deal with patients of all sizes. Five hundred pounds is the minimum weight-performance level a table needs to meet in today’s market. Bariatric patients have a higher profile when supine. Adjustable table height helps to address that issue. The increased weight capacities of the modern tables, even at extreme angles, and their high level of modularity, eliminate the need for separate bariatric, specialty, and universal surgical tables.

Imaging capability. Buyers want a table that lends itself to working with all types of C-arms, so that X-rays, MRIs, and CTs can be done right in the operating room. Thus, manufacturers offer a table top that has a different material compatible with MRI. This table also increases efficiency and reduces turnover time. These surgical tables feature intraoperative imaging capabilities, including optional radio-trans lucent carbon components, C-arm access, and head-to-toe X-ray channels for unrestricted imaging.

Modular tables. Current modular tables have components that make a single table adaptable to different kinds of surgeries. Manufacturers are launching new multifunction tables that combine greater weight capacity, full articulation, and with the appropriate modules there is the ability to have all types of surgery performed on one table. Some modular tables even provide interchangeable table components to optimize them for virtually any procedure, providing functionality, a full range of positioning options, and improved safety.

Accessibility. One thing all surgeons look for is accessibility to their patient, through proper patient positioning. Correct patient positioning, stability, and easy access contribute to patient and staff safety alike. In the old days, hospitals sometimes had to set up the patient in a reverse position, with the patient’s head at the foot-end of the table, to be able to use certain articulating functions or for certain accessories to be added to the table. Newer tabletops are fully rotatable from head to foot; they can rotate 210 and do not compromise on weight capacity.

OT Lights
Operating lights are a necessary component of any operating theatre or surgical suite and are available in a variety of different configurations, wattages, and features. A wide selection of surgery lights are available in the market currently including both large, ceiling-mounted operating room lights and small, portable exam lights. The latest generation of surgical lights uses LEDs for their light source. Surgical light manufacturers have shifted from using halogen and metal halide to LEDs for their light sources since they last longer than traditional incandescent versions and often incorporate LCD touchscreens to adjust illumination and spotlight settings.

LED surgical lights can be configured with high-definition cameras and monitors providing surgeons with the latest technology. They can be mounted on the wall and on the ceiling in a variety of configurations. Some manufacturers offer surgical lights with battery back-ups to ensure the surgical team has lighting in case of any electrical disruptions.

Indian Market Dynamics
In 2016, the Indian OT lights market is estimated at 580 crore, with 6000 units. This includes both government and private sector buying. With new technological features being introduced, the discerning surgeon needs to upgrade and replace the lights, reducing the product lifecycle to five years.

The imported segment is dominated by Maquet, Dr. Mach, Draeger, and Martin. Other brands also aggressive in this segment are BenQ (Bet Medical), Mindray, SynerG (VIVID), Magnatek, and Cognate.

The Indian OT lights contribute 83 percent to the market, with total sales estimated at 5000 units in 2016, in volume terms. The segment is dominated by Magnatek, Staan, Bharat Surgical, and Philips.

Halogen lights are gradually exiting this segment. India is perhaps one of the few countries where halogen lights are still bought in remote areas or very small hospitals. With technological development, prices have fallen, and many manufacturing facilities have been established. Many Indian companies are importing them in SKD condition from China and Israel among other countries and taking advantage of the inverted duty structure. The less requirement of energy, brighter intensity, less heat generation in comparison with halogen bulbs, and greater shelf life are some of the major advantageous factors attributing toward the increased demand for LED lights over halogen bulbs. Moreover, LED lights are designed in a way that makes them capable of producing light in the visual spectrum which could be used for illumination. Further, there is an increased trend of buying lights with multiple media arms and HD camera, although there is a 3D camera in existence but is not popular in the OT lights segment. The replacement market is huge, with the government opting for the top-of-the-line range.

Technology Trends
The last few years have seen a change in the type of lights used during surgery in OR. LEDs are now lighting up the surgical suite and are on the verge of completely replacing halogen lights in the OR. Their rapid adoption is attributed to technological advancements in LED arrays, higher brightness, better color rendering, lower prices, and a broader understanding of the lower maintenance and energy costs. They have transformed surgical lighting by offering a higher level of whiteness at a much lower temperature than halogen lights making it easier for the surgeon to distinguish between subtle differences in color.

Single color. Just a few years ago, LED-based surgical lighting systems used multicolor arrays made up of red, green, blue, and some white LEDs, mixed together to get a bright white. One drawback that was noticed by surgeons, however, was that the light would change color when they put a hand into the surgical field, blocking one or more of the colors causing a color fringing around shadows, which was objectionable to surgeons. With advancements in coating and LED technologies, pure-white LEDs now emit high-quality light.

Brightness. How much brightness is needed depends upon the surgical application, general overhead illumination, surgeon preference, other competing light sources, and more. Getting a light that has brightness similar to daylight is generally optimal for surgeons. Today’s top-tier LED-based surgical lighting systems can provide 160,000 lx of intensity as compared to traditional lighting that provided only 120,000–136,000 lx.

Heat dissipation. The LED technology has the ability to eliminate ultraviolet and infrared light waves, that contribute to wound drying and heat production respectively. While LEDs, by nature, eliminate some of the heat, the other factor in creating a cool surgical light lies in its construction. The most common choice nowadays is aluminum owing to its durability and heat-dissipation ability. These lights can be on at 100 percent intensity all day, and they are still cool to the touch.

Shadows dilution. Eliminating contrast shadows is why surgery lights often have dual or triple light heads and multiple bulbs on each light head, allowing the light to illuminate from different angles. Surgical lighting designers take different approaches to reducing shadows, the nemesis of any surgeon. For instance, one of the systems that is currently in the market uses 84 lenses to deliver light from multiple angles, which reduces shadows. One challenge in using so many overlapping lenses is that each one must be very precisely positioned and aimed.

Green technology. Focusing on all the green consciousness today, the current LED light head uses one-third less energy than the best-in-class halogen light head, and the manufacturers are coming out with new systems that will offer even greater energy savings. On the maintenance side, it is also well-known that LEDs last for years. Advantages of current LED surgical lighting are abound which saves a lot of money in the long haul.

Modern OR lightingsystems. The lighting of OR in hospitals, and, more especially of the operating zones, is a persistent problem that could interfere with certain surgical operations. Shadows, focusing, and the heat from the light source are nuisance for the surgeons. If surgeons cannot see inside their patients properly, for example, slip-ups can happen. The promiscuity between surgeons and patients, the tradition of holding courses during operations, and the fact that those OR could be used for other purposes led to an increase in often fatal nosocomial infections.

Most endoscopic surgeons around the world function in relative darkness. To make computer screens easier to see in these minimally invasive procedures, hospitals typically turn the lighting way down in endoscopic procedure rooms, unlike the bright white light associated with open body surgery. The low light levels can make instruments hard to find. It can also induce drowsiness during procedures. Even the little amount of room lighting that is used can cause glare and reflection on the video display. Keeping this in focus, some manufacturers are designing modern OR lighting systems that emit different light colors and levels in various areas of an operating or examination room, with the aim of improving visibility, increasing staff wakefulness, reducing stress, and calming nerves of doctors, nurses, clinicians, and patients alike.

Road Ahead
India has become one of the leading destinations for high-end diagnostic services with tremendous capital investment for advanced facilities, thus catering to a greater proportion of population. Improving healthcare infrastructure, large patient pool, and untapped opportunities are attracting foreign investors to hospitals and the healthcare sector, for example, Westminster Healthcare is expected to invest 125 crore in setting up a state-of-the-art center in Chennai which will provide laparoscopic and endoscopic procedures, and Columbia Asia will invest 400 crore to set up two multispecialty hospitals in India by the end of 2019. Thus, growing investments in the country and establishment of new hospitals are expected to boost growth of operating tables and lights in the next few years.

The growing demand for hybrid OR and increasing investments in infrastructure and advanced technologies for efficient outcomes are also expected to drive growth. In addition, the proliferation of multispecialty hospitals is expected to open exciting opportunities for market players in coming years.