Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees

Dooley, Ian; O’Brien, Paul D.

doi:10.1016/j.jcrs.2006.01.045

Cited by 139 publications

(113 citation statements)

References 7 publications

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“…To the best of our knowledge, only one recent literature conducted by Dooley and O'Brien 16 had a comparable study on completion rate of resident-performed phacoemulsification. They measured subjective difficulty of each step of phacoemulsification performed by basic surgical trainees and found that nucleus emulsification and capsulorhexis were the two most difficult steps to These 16 'minor' complications were not severe enough to cause the supervisor to interfere in the surgery (on the contrary, the other 'major' complications were severe or potentially severe that the supervisor took over the rest of the surgery).…”

Section: Discussionmentioning

confidence: 99%

A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates

Hou

Yang

et al. 2008

Eye

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Purpose To assess phacoemulsification learning curve by analysing residents' surgical completion and complication rates. Methods This prospective study included 226 cases of phacoemulsification performed by 11 senior residents under a single supervisor during a 27-month period. Both completion and complication rates were collected to assess their surgical results. 'Short-term completion rate (STCR)', the frequency of the surgeries completed exclusively by the residents during every five consecutive cases, was used in the evaluation of the learning curve parameter. Results These residents could complete phacoemulsification independently in 101 surgeries (44.7%). Intraoperative complications occurred in 62 cases (27.4%), of which 11 cases were complicated with vitreous loss (4.9%). By tracing different residents' individual STCRs, we found that the learning curve for phacoemulsification surgery to be of an exponential pattern, and the first STCR of 60% to be a good representation of the exponential point. Before the residents' first STCR of 60%, their average completion rate was only 16.7% and complication rate was as high as 39.2%. While after that point, the average completion rate accelerated to 76.4% and complication rate decreased to 14.2%. Conclusion The learning curve of phacoemulsification is of an exponential pattern and the trainees' STCR can be a useful parameter to evaluate their surgical performance.

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Section: Discussionmentioning

confidence: 99%

A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates

Hou

Yang

et al. 2008

Eye

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“…Constructing the anterior capsulorhexis manually is technically challenging and recognised as one of the most difficult aspects of cataract surgery to learn. 40 Despite this, it remains unenhanced by advances in technology and is still dependent on freehand, circular tearing by the surgeon. It is estimated that the manual capsulorhexis is complicated by capsular tears in 1% cases 2 and its complexity increases in cases involving shallow anterior chambers, paediatric/mature cataracts, fibrosed capsules, weak zonules or poor visibility.…”

Section: Eyementioning

confidence: 99%

The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn?

Trikha

Turnbull

Morris

et al. 2013

Eye

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Femtosecond laser-assisted cataract surgery (FLACS) represents a potential paradigm shift in cataract surgery, but it is not without controversy. Advocates of the technology herald FLACS as a revolution that promises superior outcomes and an improved safety profile for patients. Conversely, detractors point to the large financial costs involved and claim that similar results are achievable with conventional small-incision phacoemulsification. This review provides a balanced and comprehensive account of the development of FLACS since its inception. It explains the physiology and mechanics underlying the technology, and critically reviews the outcomes and implications of initial studies. The benefits and limitations of using femtosecond laser accuracy to create corneal incisions, anterior capsulotomy, and lens fragmentation are explored, with reference to the main platforms, which currently offer FLACS. Economic considerations are discussed, in addition to the practicalities associated with the implementation of FLACS in a healthcare setting. The influence on surgical training and skills is considered and possible future applications of the technology introduced. While in its infancy, FLACS sets out the exciting possibility of a new level of precision in cataract surgery. However, further work in the form of large scale, phase 3 randomised controlled trials are required to demonstrate whether its theoretical benefits are significant in practice and worthy of the necessary huge financial investment and system overhaul. Whether it gains widespread acceptance is likely to be influenced by a complex interplay of scientific and socio-economic factors in years to come.

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“…In a large multicentre audit, Johnston et al 2 found that the overall PCR rate for 79 junior trainees in their first 2-3 years of training was 5.1%, the particular high-risk period is during the first year of cataract training where the PCR rate may be double this. 7 It is well recognised that a significant learning curve exists for surgeons training to perform cataract surgery. This is the same for experienced surgeons learning the technique for the first time, [8][9][10] or trainees with no previous experience of intraocular surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical steps were learnt in order of difficulty. 7 Each step was to be repeated on subsequent cases until the trainer judged it safe to teach the next. The procedure was to be performed under topical anaesthesia unless the patient had a clear preference or there was an indication for a sub-tenons block.…”

Section: Methodsmentioning

confidence: 99%

Intensive cataract training: a novel approach

Baxter

Lee

Sharp

et al. 2013

Eye

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Purpose To evaluate the safety of an intensive cataract surgery training programme. Methods An intensive cataract surgery training programme was implemented in August 2010 for year 3 ophthalmology trainees in the East Midlands Deanery North Rotation (United Kingdom). Trainees participated in extra-ocular surgery and 50 h of virtual reality cataract surgery simulator training over a 2-year period. Their third year comprised 6 months of intensive phacoemulsification training in a tertiary centre followed by a 6-month period of consolidation in a district general hospital. The complication rates and case numbers were evaluated after the first 2 years of implementation. Results At 2 years, three trainees had completed a full year of intensive training. In the first 6 months of training, Trainee 1 completed 156 cases, Trainee 2 completed 194 cases, and Trainee 3 completed 151 full cases as primary surgeons with an average rate of posterior capsule rupture (PCR) of 1%. At 12 months, Trainee 1 completed 291, Trainee 2 completed 318, and Trainee 3 completed 294 cases, with an average PCR rate of 0.66%. The trainees required 84 lists on average to complete 150 full cataract procedures. Conclusion The combination of simulation and the new intensive training programme is safer than the traditional programme for cataract surgery training.

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Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees

Abstract: Trainee surgeons found phacoemulsification and capsulorhexis the most difficult stages of cataract surgery early in the learning curve. More time can be dedicated to mastering these steps in the wet lab.

Cited by 139 publications

References 7 publications

A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates

A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates

The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn?

Intensive cataract training: a novel approach

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