Problem

Surgical light cables, which are part of the illumination systems used during laparoscopic and endoscopic surgical procedures, can produce heat readings of approx. 450° F at their distal ends when hooked up to a standard 300W surgical light source. If left unattended and resting against flammable material (such as a patient’s surgical drapes), the cable can ignite a fire or seriously burn a patient’s skin in a matter of seconds. Other dangers include cables coming in contact with oxygen rich atmospheres or other ignition sources such as alcohol-based skin prep agents. According to the FDA Maude database, surgical light cables are one of the main sources for the hundreds of operating room fires that occur every year. Although this number alone is significant, peer reviewed publications such as The American Journal of Otolaryngology note that “Surely, these numbers are a gross underestimate of the total number of adverse events because reporting (of non-lethal and non-injury events) is largely voluntary.” Moreover, such voluntary reporting is discouraged by the fact that it leads to adverse consequences such as increased scrutiny and investigation by regulatory agencies. Consequently- fiber optic light cables pose a serious and largely undocumented fire risk to operating room staff and patients.