Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems like a tough task initially, but with practice it is similar to driving a car with a manual transmission where again, both hands and both feet are required. One of the biggest challenges for novice surgeons is learning when to apply the foot pedal in the various positions during the phaco chop technique.
This video highlights the foot pedal position during each step of surgery. The primary key for phaco chop is that the nucleus must be split while the phaco probe is securing holding the nucleus in place. The classic teaching is to buzz into the nucleus with ultrasound power (foot pedal position 3), then retract to just vacuum (foot pedal position 2), and then perform the chop technique. My preference is to just do the entire chop while in foot pedal position 3, which shortens the time window when the chop must happen, but it also makes the surgery more efficient.
Click below to learn when to use each foot pedal position in phaco chop: