June 2020
Volume 61, Issue 7
ARVO Annual Meeting Abstract  |   June 2020
A Lean Six Sigma Approach to Scleral Buckling Surgery
Author Affiliations & Notes
  • Michael Gemayel
    Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Thomas A Ciulla
    Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Footnotes
    Commercial Relationships   Michael Gemayel, None; Thomas Ciulla, Clearside Biomedical (E)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4380. doi:
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      Michael Gemayel, Thomas A Ciulla; A Lean Six Sigma Approach to Scleral Buckling Surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4380.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Lean and Six Sigma are complementary analytic approaches used for assessing and improving manufacturing practices. This improvement is achieved through elimination of waste and reduction in variation of the evaluated process. There is considerable overlap in these two methodologies, resulting in the combination strategy Lean Six Sigma used today. While these processes were initially developed in the manufacturing industry, they could be used in scientific research and health care delivery. We previously demonstrated how these principles can be applied to ophthalmology clinics, and now demonstrate their utilization in ophthalmic surgery, specifically scleral buckling surgery in effort to improve its efficiency.

Methods : The standard scleral buckle procedure was identified and listed in step-by-step fashion. Lean Six Sigma technique for process improvement was used to identify and eliminate waste and variation at each step of the procedure. The resulting optimized technique was adopted by one vitreoretinal surgeon at an ambulatory surgery center and compared to peers at this same site using their preferred method. Surgical times and single operation success rate were compared using retrospective analysis of the operative records.

Results : The average total operating time (entry to exit) using the optimized technique was 54.5 minutes, compared to a mean of 87 minutes for the 12 other retina peers, showing 37% less time required. 34/37 (92%) of primary scleral buckles using this optimized technique resulted in anatomic success with one surgery (single operation success rate).

Conclusions : The derived surgical technique for scleral buckling surgery, optimized by eliminating wasteful steps and limiting variation, shows the ability to improve surgical times while maintaining favorable outcomes and single operation success rate. This can in-turn, potentially lead to cost savings and less time under anesthesia for the patient. This also demonstrates the ability for utilization of the Lean Six Sigma approach in ophthalmologic processes, and its potential for use in future healthcare improvement.

This is a 2020 ARVO Annual Meeting abstract.


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