Course for Fugo Blade is enlightening, surgeon says

The frictionless cutting tool is approved for capsulotomy, but potential uses abound.

Issue: September 1, 2001

ByF. Hampton Roy, MD

I recently attended a Medisurg Research & Management Corporation course on the Fugo Blade and received certification for use of this instrument.

While performing anterior capsulotomies on pig eyes, I experienced a novel experience in surgery. Though I had microscope visual feedback of surgery, there was no tactile feedback. In other words, I saw the tissue being cut but realized that for the first time I was cutting tissue without any resistance.

At first glance this would seen to be impossible, but those of us attending the course experienced this new tool. I made sphincterotomies, iridotomies and scleral incision without experiencing any resistance to the cut. The unactivated cutting filament is a blunt structure with the thickness of a human hair.

Anterior capsulotomy with the Fugo Blade. One observes a 7-second anterior capsulotomy with the Fugo Blade. The surgeon has the liberty of moving faster or slower to perform this procedure.

Approved, honored

Medisurg Research & Management had received Food and Drug Administration marketing approval for its Fugo Blade in August 2000. This device is approved to perform anterior capsulotomy. It is one of the only electrosurgical units approved for intraocular cataract surgery in the United States.

This unit operates from the power of several flashlight size rechargeable batteries, which allows the surgeon to cut for about a total of 1 hour of cut time per battery charge. This issue of being powered by flashlight size rechargeable batteries to me represents a plus for patient safety.

The Fugo Blade was honored for technical achievement by the American College of Eye Surgeons (ACES) by being chosen as the topic for the keynote lecture (the John H. Sheets Memorial Lecture) at the 2001 ACES meeting in Bal Harbour, Fla. ( February 2001).

Dr. Fugo’s demonstration

At the beginning of our wet lab session, Dr. Fugo placed a drop of viscoelastic on his finger then touched the activated tip of the Fugo Blade onto the drop of viscoelastic. While the lights were on, one could see a vague hint of “something happening” on the activated tip. He then had the room lights turned off. Suddenly, we could clearly see a “small twinkling star” on the end of the Fugo Blade tip. It actually looked like a miniature light bulb. That was our first impressive experience in the wet lab. We then had the opportunity to experience resistance-free incisions.

The glow seen at the end of the Fugo Blade cutting tip is important. This unit uses energy from the flashlight-size rechargeable batteries, processes this energy through the unit console then concentrates the processed electromagnetic energy on the blunt cutting tip. This results in about 1 watt of power so concentrated that it glows. Recall that Dr. Fugo demonstrated the Fugo Blade glow in a drop of viscoelastic on his finger, although he made certain that the tip did not hit his finger, or it would have created an incision in it.

Dr. Fugo allowed surgeons to touch the viscoelastic after the Fugo Blade tip was activated in it for awhile. Interestingly, the drop of viscoelastic was not hot. But thinking about it, you would not expect much heat to be generated. The energy of this system is confined to several flashlight-size rechargeable batteries. Since the batteries support cutting for a period of more than 1 hour’s duration, the amount of total energy delivered per second must be quite small.

By properly filtering the activated tip image (left), one can see that the tip is dark in the center of the bright energy field. This demonstrates a lack of blackbody effect glow indicating that the tip is cool. The energy concentrated around the Fugo Blade tip is visualized under high magnification (right). The orangish outer glow is visualization of light photons arising from the brighter central energy core surrounding the tip.

By concentrating small levels of energy, the unit apparently can create a minute sphere of energy intense enough to glow. As seen in many articles over the past several years, Dr. Fugo and colleagues have been studying unique ways of generating plasma clouds and focusing energy into minute channels which may be used for surgery.

Applications

This tool appears to have unlimited applications in ophthalmology as well as other surgical fields. I can imagine this device in endoscopic surgery.

Daljit Singh, MD, of India has used the Fugo Blade for human surgery in the following areas:

Adult cataract capsulotomy and pediatric anterior and posterior capsulotomy.
Open-angle glaucoma in a creative filtering procedure that takes less than 2 minutes per eye. I have seen videos of this procedure in human eyes and it is quite impressive.
Iridectomy and mini-sphincterotomies.
Creating puncta in punctal atresia.
Ptosis surgery. Here Dr. Singh also makes the skin incision and said that dissection of the orbicularis gives such a clean tissue plane that he now has a new appreciation of orbicularis structure.
Pterygium.
Treating corneal ulcers.
Marfan syndrome.
Electrolysis for misdirected cilia.
Vitrectomy. Here the device apparently ablates or vaporizes the vitreous in its path without creating any vitreous traction.

I am sure that surgical procedures with this novel technology will be refined and increased when more ophthalmologists use this technology.

In my opinion, this is the most exciting addition to ophthalmic surgery since the introduction of laser. When I took the Fugo Blade course, the units were on 4- to 6-week backorder. The unit cost is $15,000.

For Your Information:

F. Hampton Roy, MD, can be reached at 9800 Lile Drive, Suite 660, Little Rock, AR 72205; (501) 227-6980; fax: (501) 227-8144; e-mail: hamproy@aristot le.com.

Medisurg Research and Management Corporation, manufacturers of the Fugo Blade, can be reached at The Fugo Building, 100 West Fornance St., Norristown, PA 19401; (610) 277-3937; fax: (610) 277-7256; Web site: www.fugoblade.com.