Hands or Machines: What is more important?

There is an old saying, “a good workman never blames his tools,” and that holds true for ophthalmic surgery as well. Your hands are your most valuable instruments in surgery. Remember that the machinery and instrumentation that we use can make us better but they cannot make up for deficient hands. Many of the readers of CataractCoach.com are using phaco machines and microscopes which are at least a decade old, if not older. And yet these surgeons still do beautiful surgery to restore vision to their patients. These surgeons know that it is not the instruments that make us good, but instead it is how we use these instruments. If there is a complication in surgery it is rarely the fault of the instruments or machines, but more likely the manner in which they were used.

For certain, upgrading to the latest technological advances in equipment can assist us in producing even better outcomes with lower risks and faster visual recovery. In Los Angeles, our surgery center in Beverly Hills has every conceivable piece of equipment, the latest in high-tech devices, and new technology that is simply amazing. For my patients who have surgery in this facility, congratulations because it is the best of the best, but this is also why the costs are higher there. In order to purchase millions of dollars of equipment, the surgical revenue must be sufficient to justify the costs

In another center in Los Angeles, I have operated in a surgery center where the microscope and phaco machines are much older without any of the newer advancements. In the photo shown here, I’m operating using a Zeiss microscope that shows it was made in West Germany, which ceased to exist in 1990. That means that this microscope is about 30 years old, but it is sufficient for me to still do a beautiful cataract surgery for these patients. The difference in cost compared to the latest microscopes is tremendous, with the newer ones costing about 30 times as much.

When I was a young child, I thought that the newest athletic shoes would make me a faster runner, but it turns out that was not the case. Now, when I teach my ophthalmology residents, I try to remind them that the limitation for surgical success is primarily their hands and not just the equipment. This is particularly true early in the learning curve of surgery, but still rings true even in the hands of very experienced surgeons.

Maximize your access to the best devices, instruments, and platforms, but remember that at the end of the day, the most critical factor is the surgeon, his hands, and his judgment.