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Brian R Sullivan; Resident Surgeon Efficiency in Femtosecond Laser Assisted Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):944.
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© ARVO (1962-2015); The Authors (2016-present)
The objective of the study is to compare procedural efficiencies of resident performed femtosecond laser assisted cataract surgery versus conventional phacoemulsification.
A retrospective chart review was conducted for consecutive senior resident cases of phacoemulsification cataract surgery performed under single attending supervision during a nine month period. Medical records were reviewed to record demographic information, operative procedure interval times, total OR room interval times, and surgical complications. Operating room video records for each case were reviewed to quantify interval times for completion of five core steps of the procedures, including incision, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation.
Total room time, total operation time, and incision time were all found to be significantly longer in the laser group versus the traditional phaco group (each p < 0.05). The mean difference in total operating time for the FLACS group was 8.6 minutes longer than the traditional group (p < 0.001). Average total room time was 9.0 minutes longer in the FLACS groups (p = 0.02). By contrast, the mean duration for manual completion of anterior capsulotomy was significantly shorter in the femtosecond laser group compared to traditional phacoemulsification (p < 0.001). There were no statistically significant differences for the individual steps of nucleus removal, cortical removal, or IOL insertion and placement. Rates of surgical complications were not significantly different (p=0.22) between the groups.
Early resident experience with femtosecond cataract surgery is generally less efficient than traditional phacoemulsification regarding total OR time, total procedural time, and incision time. FLACS showed a small advantage in shorter mean time for manual completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparity of efficiency. The study did not show a significant difference in operative complications between FLACS and conventional surgery by the trainees. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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