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OR time for femtosecond cataract surgery longer than for standard surgery
The extra step of laser pretreatment lengthens surgery time.
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Patients spent 11 minutes to 12 minutes longer in the operating room for femtosecond laser-assisted cataract surgery compared with traditional cataract surgery, according to a retrospective review of data from three experienced cataract surgeons.
The study, which appeared in the Journal of Cataract and Refractive Surgery, also found that among routine cases only, the femtosecond approach lengthened operating room time by 11.6 minutes to 13.4 minutes. Both differences were statistically significant (P < .0001).
Sonia H. Yoo
“With the emergence of femtosecond laser technology for cataract surgery, one of the questions many surgeons ask when evaluating the technology is, how does this affect your efficiency in the operating room?” co-author Sonia H. Yoo, MD, a professor of ophthalmology at Bascom Palmer Eye Institute, said. “Logistically, what areas of the process take time, and how can you maximize your workflow with the device?”
Comparison with other studies
Other studies have assessed operating room time for femtosecond laser-assisted cataract surgery.
“However, those studies have not included the actual laser portion because the majority of surgeons keep their laser outside of the operating room,” Yoo told Ocular Surgery News. “In these cases, laser pretreatment is performed before the patient is brought into the operating room.”
As a result, many of these studies showed that the operating room time for the femtosecond-assisted procedure is actually shorter than for conventional ultrasound phacoemulsification.
In contrast, the current study used a setting in which the laser is in the OR, for a time assessment from “wheels in” to “wheels out” of the operating room.
“I was not surprised by our results,” Yoo said. “The laser surgery definitely takes longer than conventional cataract surgery due to the extra step of laser pretreatment. It also takes time to transfer patients to the laser bed and position them properly.”
Results of study
During the first 6 months that the femtosecond laser was used in the study by the three surgeons, including Yoo, 420 cataract cases were performed, with the laser employed in 162 cases (38.6%). The mean patient time spent in the operating room was 34.2 minutes for conventional cataract surgery and 48.2 minutes for laser cataract surgery.
The investigators separated the first 50 cases from the last 50 cases to determine if there was a significant time difference to account for the learning curve of the laser.
“It was a surprise to us that there was not a meaningful time difference,” Yoo said. “What this says to me is that the learning curve is fairly flat with the laser device.”
Because of the additional time associated with laser treatment, many surgeons have elected to remove the laser from the operating room and place it in a clean laser room.
“Surgeons will laser treat a number of patients back to back and then transfer the patients to a holding area before bringing them individually into the operating room for back-to-back phacoemulsification,” Yoo said. “By doing this, I suspect the overall time of the cataract surgery is slightly reduced. It is a viable option that could improve the workflow, depending on your practice setup.”
Points to consider
Yoo said patient selection is important when considering laser treatment.
“The patient needs to be able to maintain a flat position with a steady head,” she said. “The patient also has to cooperate with the instructions.”
Yoo and colleagues are continuing to evaluate operating room times for the femtosecond laser, specifically among less experienced resident and fellow surgeons.
“We might find that using the laser by these surgeons might actually decrease operating time or not increase as much compared to starting out with standard cataract surgery because you are automating the more difficult surgical steps,” Yoo said. “There may be less of a disparity in time between laser vs. non-laser surgery.” – by Bob Kronemyer
Reference:
Lubahn JG, et al. J Cataract Refract Surg. 2014;doi:10.1016/j.jcrs.2014.03.024.For more information:
Sonia H. Yoo, MD, can be reached at Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17 St., Miami, FL 33136; 305-326-6322; email: syoo@med.miami.edu.Disclosure: Yoo is a paid consultant to Alcon Laboratories and Abbott Medical Optics.