About 15 years ago, bimanual phaco was relatively popular. The idea is that by separating the infusion from the aspiration, you can have better control of the fluidics while using smaller incisions. This became possible because of phaco power modulations where we can allow better cooling of the phaco needle using a lower duty cycle, burst mode, and other modalities. The phaco needle is placed into the corneal incision without a silicone sleeve which means less insulation to protect against a corneal wound burn. There were even specialized instruments such as irrigating choppers. Our guest surgeon is Chiritoi Sergiu MD from Châteaubriant, France and he demonstrates this technique.
click to learn from this bimanual phaco technique and hear my perspective: