Some surgeons love the pre-chopper because it allows for efficient splitting of a nucleus, usually into quadrants. This surgeon takes it a step further and divides each of these quadrants in half, thereby creating 8 pieces of nucleus. Each of these eighths is then phaco-aspriated using just the phaco probe and no second instrument. In fact there is only one incision in this eye as the non-dominant hand is not as active in this technique. Clearly this technique is efficient in the hands of our guest surgeon. Have you tried the pre-chopper? Please let us know.
The technique shown in the video is the karate prechop, a la Akahoshi. Karate prechop is suitable for moderately dense lens nucleus. For denser lens nucleus, the counter prechop is preferred. Counter prechop is performed with a lens sustainer. I have found the Seibel chopper (the smooth end) works equally well. In karate prechopper, the prechopper is pushed vertically (slowly and gently) toward the center of the nucleus. In counter prechop; the prechopper is directed more horizontally, starting the proximal mid-periphery of the lens nucleus, aiming toward the tip of the sustainer, going slowly and gently into the center of the lens nucleus. After the lens nucleus is spilt into the desired number of fragments, injecting dispersive viscoelastic between the fragments will facilitate the complete separation and the removal of the fragments. If prechop fails to divide the lens nucleus, you can go to phaco chop to finish the case. Prechop is contraindicated in the presence of zonular weakness or dialysis.
I prefer phaco chop, the technique works in all kind of cataracts. The prechop functions well in not all cases. A second instrument makes the surgery more versatile and efficient