Abstract
Purpose: :
To evaluate initial vitrectomy training comparing 20–gauge (20G) vs. 25–gauge (25G) systems by examining parameters of efficiency and safety.
Methods: :
All cases or portions of cases done primarily by the fellow using Alcon Accurus 2500 20G and Alcon 25G vitrectomy were included. Main outcome variables recorded were opening and closing times, total surgery and vitrectomy times, complications, and average cut rates.
Results: :
Comparing combined opening (13:45 and 3:23) and closing (14:40 and 1:17) times in minutes for 20G and 25G respectively, resulted in over a twenty–minute reduction in surgical time (23:52, p<0.001) using 25G vitrectomy. Total surgical times for uncomplicated vitreous hemorrhages due to diabetes showed a trend towards reduced surgical times for 25G vitrectomy (1:27:43 and 1:42:14, p=0.28; 25G and 20G respectively). Average vitrectomy times showed non–significant reduction using 20G vitrectomy (8:13 and 29:40, p=0.13) with average cut rates per minute being 2078 and 1355, 20G and 25G respectively. A single sclerotomy break was observed using the 20G system and a peripheral retinal touch using 25G vitrectomy with no resultant retinal detachment in each case. One 25G sclerotomy required suturing. No recurrent bleeds, secondary retinal detachments, postoperative hypotony or choroidal detachments were observed.
Conclusions: :
Initiating retinal surgical training with both 20G and 25G vitrectomy appears equally safe comparing complication rates in this study. Subjective fellow comfort level with initial exposure to both systems was equal with certain aspects of a case showing greater ease of use with a particular system. The cause of the 20G sclerotomy break was undetermined after review of the surgical video, but the peripheral retinal touch with the 25G system may have been related to the reduced illumination with the 25G light pipe. The 25G vitrectomy may be a more efficient technique at the initiation of training with a nearly 24 minute reduction in surgical time for opening and closing wounds and trends showing possible overall reduced surgical times. As a surgeon progresses in his or her training the differences in opening and closing may be reduced and the possible more rapid vitrectomy using the 20G system may reduce the time difference. Alternatively, earlier exposure to 25G vitrectomy may refine surgical technique and comfort and this increased efficiency may persist. Overall, based on our study we feel initiating retinal surgical training with 25G vitrectomy system is a safe and possibly more efficient method for beginning fellows in cases where 25G vitrectomy is indicated.
Keywords: vitreoretinal surgery • retina