Rushing during surgery, especially cataract surgery, is a bad decision. It can lead to complications which can cause a poor visual outcome and it actually slows down the surgery. Cataract surgery is not a horse race and we really should not watch the clock (and never race the clock) when operating. Efficiency, however, is an entirely different concept and we can certainly do safe surgery while being efficient.
I have had the fortune of traveling across the US and around the world to watch ophthalmologists operate in their own surgery centers, hospitals, and operating rooms. The best surgeons have very efficient surgeries because they do not have wasted movements and they tailor the procedure to the patient. There are trade-offs between various techniques of surgery and we choose the one that best fits the situation.
In the case presented here, the patient has a history of spasticity along with a host of other complex systemic medical issues. The anesthesiologist determined that the safest approach was to give the patient an intra-venous propofol bolus for sedation. This would give us about 5 to 10 minutes of deep sedation in which to accomplish the cataract surgery. Should the case run longer, he advised moving to a propofol drip but that was something that he wanted to avoid.
The cataract in this case is relatively soft, so the safest approach is to bring it out of the capsular bag and then chop / emulsify it at the iris plane. In advance of the first incision, everything was prepared and ready to go including already having the lens in the injector, setting up the phaco and I/A tip sleeves, and more.
The case was very efficient and we were able to complete the case, remove the drapes, and medicate the eye within the requested time. Again, this is a case study of efficiency and not a recommendation to race the clock during surgery.
click below to watch the video of efficient cataract surgery:
