The operating theater is generally the most expensive facility in a hospital, and also a significant revenue driver. The onus lies upon the vendor to ensure that sufficient funds are allocated from the total procurement budget for OT tables and OT lights.

Hybrid operating rooms are extremely complex working environments where a large team of surgeons, interventionalists, nurses, anesthesiologists, and technicians work seamlessly together. And technologically up-to-date equipment ensures precise operation.

Operating Tables

The operating table is an essential part of any successful surgical procedure. Appropriate posture and keeping patient in the best position is desired for a surgical procedure to be performed effectively. A surgeon should be able to change his position easily.

ot-tables

The vendors cater to the market extensively. There are general surgery and specialty surgery tables. General surgery tables are further specialized as tables for acute care, ambulatory care, and bariatric tables, while specialty surgery tables are customized for orthopedics, ortho and spine, and image-guided surgery. Unit cost increases as specialty gets complicated, with the top-of-the-lineorthopedic and spine tables, costing as high as Rs. 8,000,000. On an average, specialty surgery tables cost around three times as much as general surgery tables. Surgical tables may be further categorized according to location in the OR, such as stationary or mobile; drive-type; panel characteristics, such as X-ray transparent or opaque; and properties of bed material. Some other variables include table height, panel slope and section slope adjustment by Trendelenburg or reverse Trendelenburg.

It is the powered operating tables which are increasingly finding popularity with the surgeons as it gives them ease while performing surgery. However, with the increase in supply voltage, often leakage from cables increases prominently, especially when in remote control. This is being resolved by the vendors.

Indian Market Dynamics

In 2015, the Indian OT tables market was valued at Rs. 240 crore with sales at 3000 units.

The quality of Indian tables has improved over the last couple of years, resulting in better unit realization, albeit cost of manufacturing has also increased. However, compared to imported tables, they remain competitive on pricing.

Cosmetic surgery and bariatric high-load-bearing tables continue to see an increase in demand. Other high-end tables for neurology and cardiac surgery are also gaining share.{mosimage}

The newly set up private hospitals, with major investments have provided impetus to this market. For instance, Aster DM Healthcare, with six hospitals at Kochi, Calicut, Bangalore, Hyderabad, Pune, and Kolhapur expanded operations in 2015-16. It invested Rs. 550 crore in Aster Medicity at Kochi, and Rs. 230 crore in its greenfield hospital project at Bangalore. Medanta spread to Tier-II cities, with new hospitals and operation theaters, as many as 30 in each facility at Lucknow, Indore, and Jabalpur. Government buying too was good in 2015, with new hospitals being set up across the country. Schmitz, Famed, and Surgdent had some success with bids invited by government hospitals.

Continued demand was exhibited as when customs duty was hiked by 7.3 percent for other items, OT tables continued to enjoy 22 percent.

With the current scenario, this segment is poised to grow over the next few years, with Indian brands gaining traction.

Global Market

The global surgical tables market was valued at USD 762.6 million in 2015 and it is expected to reach USD 886.7 million by 2020. The market in general surgery tables is forecast to remain relatively stable over the period to 2016; however, this will be balanced by an increasing demand for specialty surgery tables, according to Global Industry Analysts.

USA dominates the global market in operating tables, with the Asia-Pacific region representing the fastest growing market in this area. By 2016, the combined US market for surgical tables is expected to reach over USD 197 million.

Vendors continue to make innovations that challenge the operating room market and drive demand among hospitals to upgrade their existing tables. Some of the major trends that have been observed in the global market for operating tables include companies involved in R&D for new innovative products for better efficiency. Increasing applications of operating tables are expected to offer good opportunities to the market.

The market for operating tables is expected to be driven by the increasing number of operating rooms, cost effectiveness, and new and advanced technology involved. Some of the other drivers include increasing hospital-going population, rising government initiatives for enhancing healthcare infrastructure, and specifically, reduced surgery timings and ease to surgeons. General economic slowdown may be a deterrent.

Market Trends

As life span increases, surgeries required by the older generation get complex, which has resulted in the development and adoption of technologically advanced and ergonomically designed operating tables offering versatility in the operating rooms. The top three emerging trends driving the operating table market are rise in ambulatory surgical centers, advances in technology, and rising popularity of hybrid operating tables.

Rise in ambulatory surgical centers. The transformation of healthcare systems worldwide, from being physician-centric to patient-centric, has increased the need for ambulatory surgery centers (ASCs), which provide patients the accessibility to undergo surgeries safely outside the hospital setting at a shorter duration. The shorter duration of hospital stay reduces financial burden on patients for certain procedures, which increases the number of patients opting for ASCs. This presents significant opportunities for surgeons to establish their own ASCs. Around 70 percent of the total surgeries performed globally are day-care surgeries and of late this trend is also on the rise in India. In India, almost 60 percent of all surgeries can be done in a day-care mode as the current infrastructure supports it.

As these facilities significantly reduce hospitalization costs, medicare and other private insurance companies are also encouraging patients to undergo surgeries in outpatient facilities. This will encourage surgeons to opt for MI procedures for treating many disorders, as they are cost-effective, reduce pain and infections, and provide rapid results. The practice of MI surgeries in unsaturated markets may increase the number of physician-owned ASCs.

Advances in technology. Advances in technology have led to the implementation of high accuracy and precision laparoscopic procedures, provision of better support to surgeons, and an increase in clinical patient outcome. Medical facilities need to adopt technologically advanced operating table equipment to offer the best possible surgical services to patients.

Vendors are continuously engaged in R&D to offer technologically advanced and innovatively designed operating room equipment such as operating tables (to offer better and more patient positioning options). Technological advances in the operating table have outsmarted the standard operating table after the introduction of radio translucent material, addition of C-arm imager, and integration with robotic arms.

Rising popularity of hybrid operating tables. The number of hybrid operating tables in healthcare facilities has increased worldwide over the past decade. The advances in tables have led to the development of mobile, integrated, and hybrid surgical operating tables. Considerations such as compatibility, integration of imaging devices, and position in room (carbon fiber table top), adjustable height, floating (horizontal, lateral, and vertical) are important factors for hybrid operating tables. These tables, with floating table tops and cradle and tilt, have increased the mutual demand for surgical and interventional requirements.

Most of the operating tables require imaging for which full-body coverage is required. Therefore, a non-breakable carbon fiber table top is used in hybrid operating tables. These tables are mostly adopted by orthopedic surgeons, neurosurgeons, and general surgeons. During angiography, cardiovascular surgeons need easy positioning, which is provided by hybrid operating tables as they possess floating table tops, which allow precise and fast movements during surgical procedures. Hence, the rising popularity of hybrid operating tables will increase the demand for operating tables in the market.

OT Lights

ot-lights

Surgical lighting is an integral component of every operating room (OR). In the past, surgical lighting was manufactured by companies that did not offer full integration solutions for the OR. Surgical lighting was included in integrated OR packages due to strategic relationships and mutual agreements between the surgical lighting manufacturer and the integrated OR manufacturer.

Many facilities have not yet upgraded their lighting system, meaning that there is still a relatively large halogen-installed base, which is helping drive the growth of LED light systems. LED surgical lights require a higher initial investment than their halogen counterparts; however, LED surgical lights also provide higher light intensity at a lower wattage than halogen lights, resulting in lower energy consumption. The longer life span and lower cost of operation of LED surgical lights ultimately results in a much smaller total cost of ownership, creating a high demand for such systems.

Indian Market Dynamics

In 2015, the Indian OT lights market was valued at Rs. 185 crore with sales at 4300 units. This was an increase in the number of lights as compared to 2014, and yet a declining market in value terms. Overall unit prices have decreased, resulting in a smaller price differential between imported and Indian brands; the market is thus seeing a major increase in imported ones.

The imported lights have gradually emerged as premium lights and regular ones. About 200 units of top-of-the-line lights, including camera systems are procured from Maquet, Steris, and Martin.

It is roughly estimated that the replacement market would account for about 33 percent of the total market. On a similar note, it is estimated that the government procurement, a discerning buyer, would account for 30 percent of the market.

Till last year, variable color temp was a sought-after feature. However, now almost all lights are equipped with this feature. Color differentiation helps the surgeon to determine where and what to cut. Lower-color-temperature lights, which appear yellow, have more of their energy in the red end of the color spectrum, overwhelming the blue and purple tones, producing a washed-out appearance. High color temperatures, which appear white or blue, are more balanced, mimicking the true white light of noon-day sun, giving surgeons the subtle contrasts they need to distinguish one structure from another.

There has been a distinct shift from SD cameras to HD cameras.

Although LED lights have become the norm, there is distinctly a casual attitude observed in Indian vendors and buyers, both. Applications as for cardio, neuro, and cosmetic surgery could have 25 separate LEDs, as against the desired 100 separate LEDs.

The Indian lights continue to have a glare and shadow, which can contribute to the surgeon's eye fatigue. Surgeons' eyes need to see structures and deep into cavities. In surgical sites, light is absorbed because tissues are dark and non-reflective. Quality surgical lighting delivers high-intensity lighting to the surgical site without glare or shadow, to assist surgeons to best see and interpret tissue, vessels, etc., with the highest degree of accuracy. Visualization is of critical importance to the surgeon and surgical team. Next to the surgeon's eyes, no other surgical tool is more important than lighting. Many surgeons will do two or three cases a day under high-intensity illumination. Highly intense but soft illumination without glare allows surgeons to get optimal light to the surgical site for long periods without associated eye fatigue.

Indian manufacturers do not spend money on R&D to assist heat sinking. Thermal management of the light must, by design, minimize beam temperature and radiant energy toward the surgical field. A combination of low energy consumption together with proper heat dissipation guards against tissue desiccation, just as importantly, provides optimal comfort for the surgeon and surgical team working under the surgical lights.

Global Market

The global OT lights market was valued at USD 580.46 million in 2015 and is expected to grow at a CAGR of 4.6 percent from 2015 to 2020, to reach USD 728.92 million by 2020. Globally, the OT lights market is witnessing significant growth due to innovations, along with technological advancements and rise in the number of surgery centers. Moreover, increasing demand for better healthcare facilities and the rise in number of surgeries are also driving the growth of the market. Complications associated with CFLs, high cost of CFL and LED lamps, and economic slowdown in some regions such as Europe and Africa, inhibit the growth of the market.

North America is the largest region and Asia represents the fastest-growing region in the surgical lamps market. This is due to initiatives taken by various governments to promote the usage of energy-efficient OT lights in the regions. Furthermore, increasing numbers of surgeries, growing aging population, and rising incidence of age-related diseases are also boosting the growth of the European surgical lamps market

LED represents the largest and fastest-growingtechnology in OT light market. High color rendering index (CRI) light lamps account for the largest segment, while vein light lamps are the fastest-growing light lamps segment in the market.

Sanjay Agarwal, Managing Director, Magnatek Enterprises
Industry Speak
Choosing the Right OT Table and Lights

Choice of right OT table and lights helps in reducing stress on surgeons while operating.

What to look for in a modern OT table?

The table should not have any nuts and bolts on the table top as this makes the cleaning of table very easy and chances of infection spreading are greatly ruled out. The table top should be made of a composite imported radiolucent material which can give clear images during imaging. Specialized attachments, with which the surgery procedure time is greatly reduced, are a must. Generally all OT tables start at a height of 32" but there are OT tables that start at 25". Low height helps surgeons as they can operate while sitting. Slide of the table top with remote control helps in repositioning of the patient while operating. There are OT tables which have this feature wherein the table top comes back to the zero level from any tilt position with just a click of a button. Apart from the remote control, there should be a provision to operate all the controls through another parallel console. An infrared (IR) cordless remote control is a very special feature where all the operations of the table can be done from a distance without touching the sterile area.

OT tables should be capable of being upgraded by adding new attachments and features; non-hydraulic tables are more useful.

Look for the certifications like CE and ISO 13485 to ensure that OT table is manufactured according to international quality. Last, but not least, getting a table with all the above features at reasonable price is difficult but such tables are available in the Indian market.

LED Lights

Buyer should look for Led lights with features like high brightness with a luminance of 180000 lux on each dome; 3500 Kelvin to 5000 Kelvin adjustment; temperature increase should be less than 1 degree; life of light up to 40,000 hours; and they should have multiple options of single-dome, double-dome, ceiling-mounted, mobile with battery backup, mobile spot light, etc.

Sanjay Agarwal
Managing Director,
Magnatek Enterprises

Sanjeev Saini, Managing Director, Care Medi System Private Limited
Industry Speak
Witnessing Changes

The operating room is a facility within a hospital or a clinic, which is used for performing various surgeries on patients in order to treat different physiological and pathological conditions.

Operating theaters are undergoing a transformation by adopting new designs, concepts, and technologies. Operating room equipment lies at the heart of this transformation. It is projected that this market will grow from being worth USD 2.67 billion in 2012 to an estimated worth of USD 4.05 billion by 2019. The market is predicted to demonstrate a CAGR of 6.2 percent over the next three years. The global operating room market in Asia-Pacific is expected to grow at a CAGR of 14 percent.

Detailed analysis of the various equipment that form an indispensable part of the operation theater include: operating tables, surgical booms, integration systems for operating theaters, operation theater lights, as well as imaging display systems and more.

Operating rooms are witnessing a change, steadily moving from conventional equipment and techniques to state-of-the-art operating theaters that can be best described as hybrid. This transformation has been crucial because the operation theater contributes a considerable share to the overall revenue generated by a hospital or healthcare facility. Besides providing better care for patients, it also helps surgeons achieve better efficiency and accuracy in critical surgical procedures.

The operating table, on which the patient is placed for surgical procedure, is one of the most crucial equipment used in the operating theater. The market for operating tables constituted the largest segment within the operating room equipment market, with a 30.6 percent revenue share worth USD 815.5 million.

However, the fastest-growing segment within this segment is that of operating theater integration systems and surgical booms. This growth is largely propelled by the growing demand for operating rooms that are hybrid and comprise equipment that offers better integration and space management.

As hospitals struggle to balance costs and savings potential, many are turning to advanced technological offerings. Hospitals looking at long-term benefits are opting for these capital intensive facilities and are opting for the latest medical technologies at affordable rates and simultaneously the compliance with international quality standards.

Sanjeev Saini
Managing Director,
Care Medi System Private Limited


 

randox

Digital version