Resident surgeon efficiency in femtosecond laser-assisted cataract surgery

Abstract

PurposeComparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification.Patients and methodsA retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation.ResultsTotal room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05). Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001). There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups.ConclusionIn early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training.

Femtosecond laser–assisted cataract surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery: Baseline characteristics, surgical procedure, and outcomes

“…It has been reported that the laser corneal incision takes significantly longer time than a manual corneal incision and this may contribute to a lower usage of the laser for corneal incisions. 12 Correction of astigmatism was not used to any great extent; less than 10% of the eyes were treated for astigmatism. The impact of this treatment as well as use of toric IOLs will be described elsewhere.…”

FLACS vs conventional phacoemulsification by junior cataract surgeons: randomized trial

“…31,33 Pittner and Sullivan retrospectively reviewed operating room videos of senior residents and evaluated the time taken for each step of the surgery. 31 They found an increase in the operation time and total room time when residents performed FLACS as compared to PE. Brunin et al, on the other hand, found a lower CDE and posterior capsule rupture in the FLACS group when performed by resident surgeons.…”

“…Previously published literature comparing FLACS and PE in the hands of residents reported no significant differences in the efficiency or complication rates between the techniques. [31][32][33] However, considering the paucity of literature evaluating FLACS vs PE in the hands of junior surgeons, this study was aimed at comparing outcomes with FLACS and PE in standard cataracts when performed by less experienced surgeons.…”

The influence of surgeons and technicians on the learning curve of femtosecond-laser cataract surgery

“…For instance, a recent meta-analysis didn't show any significant safety and efficacy benefits of femtosecond-assisted cataract surgery vs. conventional cataract surgery, 4 whereas another study showed a categorical advantage for the femtosecond laser technique. 5 A study by Pitter reported that the outcomes delivered by resident surgeons when using femtosecond-laser surgery may be worse than those yielded with conventional surgery, 6 where they have already gained and built up experience.…”