Performing surgery at a high level is a skill that must be continually honed and practiced. What happens when we are away from the operating room is a gradual waning of surgical skills. Experienced surgeons are aware of this and if they take an extended vacation, they know that they should gradually ramp up their surgical volume and complexity of cases when they return.
Due to the COVID-19 virus, many ophthalmologists took a hiatus from their clinics and their primarily elective surgeries. I was fortunate to still work with our ophthalmology residents performing more urgent cases such as acute glaucoma and traumatic ruptured globes. We also combined surgeries to perform everything at once for complex, end-stage cases such as neo-vascular glaucoma: anti-VEGF injection, pan-retinal photo-coagulation with the indirect laser, cataract surgery, and placement of a glaucoma drainage implant — all in one sitting.
If you are anticipating a prolonged hiatus from ophthalmology, such as pursuing further education like an MBA degree or performing lab-based bench research, it is helpful to spend at least a day or two a month still performing surgery. I’ve met a few ophthalmologists who spent a few years away from the operating room and now face a big challenge in an attempt to return to performing surgery. As the saying goes, “Keep your hands wet!”
The surgeon featured in this video took three months off from doing surgery and then was presented with this tough surgery as his first case back. The patient has a small pupil, dense cataract, pseudo-exfoliation, and floppy iris syndrome. This is a challenge for any surgeon! His approach was great and offers many good teaching points. He sets up for success by giving good anesthesia, properly draping the surgical field, and using a pupil expansion ring. The result is careful and meticulous and the case goes beautifully.
click below to watch this surgery and hear my thoughts about getting back to the OR:
