When we watch videos of cataract surgery it seems like a solo act by the surgeon. While the surgeon is the most crucial member of the team, always remember that cataract surgery is teamwork.
The team members in the USA often include:
- the surgeon (the ophthalmologist)
- the scrub tech (surgeon’s primary assistant)
- the anesthesiologist
- the circulating nurse
- the ophthalmic tech in the clinic
- the pre-operative nurse
- the post-operative nurse
- the surgical coordinator / scheduler
- the rest of the team
Remember that a great surgery requires that the entire team is functioning and working together. In the video presented here, I am working with a new scrub tech and new anesthesiologist for the first time. The scrub tech has difficulty in positioning the patient and placing the eye drapes. This results in a central corneal abrasion which impairs the view during the entire surgery.
In this surgery there are many steps which could have been better:
- avoidance of a central corneal abrasion from the draping procedure
- better draping of the patient to provide an optimal operative field
- accurate head positioning to place the iris parallel to the floor
- not allowing saline to touch the microscope lens in the middle of the case
These are, admittedly, minor issues and this patient still ended up achieving a beautiful result and 20/20 vision. Also the surgery was still completed in 6 minutes without complications or issues. But still, the critic in me says that it could have been just a bit better. And that’s what cataract surgery is about: getting incrementally better every case.
When my scrub tech, who has helped me with thousands of cases, makes a suggestion during surgery, I always heed her advice. Her opinion is valuable and she has insight that is not tainted by the hint of denial that we surgeons sometimes have.
Your anesthesiologist understands the patient’s systemic health far better than any ophthalmologist and you should trust his/her judgment. When my anesthesiologist tells me that it’s better to postpone surgery for a particular patient for medical reasons, I trust his judgment and do exactly that. Cataract surgery is elective and there is no sense in taking unnecessary risks to do a surgery today if it can be done in a safer manner in a few weeks.
Next time you operate, follow my rule: at the end of the surgical day, take time to thank each and every member of your surgical team!
Click below to watch the video:
