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In-office vitreoretinal surgery may be routine in future
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VIENNA — The latest advances in small-gauge vitreoretinal surgery have encouraged U.S. surgeons to move many of their procedures to ASCs.
“There are currently 5,500 ASCs in the U.S. doing 25 million surgeries. We feel comfortable with it, except for cases with systemic comorbidities and those who need general anesthesia,” Dante J. Pieramici, MD, said at the Advanced Retinal Therapy meeting.
Dante Pieramici
His group practice, California Retina Consultants, has 10 ASCs in different locations with the best technology and specifically trained personnel. The majority of vitreoretinal procedures are performed there under sedation and retrobulbar/peribulbar injection. A small minority of patients, about 5% to 10%, are referred to the hospital for general anesthesia and/or an overnight stay.
The next step might be to perform vitreoretinal procedures in the office, Pieramici said.
“The main hurdle I see to this is the cost of buying microscopes, vitrectomy machines and the rest of the equipment for surgery. The cost and large footprint of sterilization may also be an issue in individual practices,” he said.
Although offices may not have the controlled ventilation system of operating theaters, there are no major concerns, according to Pieramici.
“Not as long as the equipment is sterile and not sitting out for a long period of time,” he said.
The SurgiCube (SurgiCube International) may be an option for those who wish to equip their office with an optimized laminar airflow system.
“It’s a good option, but maybe more important for surgeries with large wounds like abdominal surgery. Our wound are as small as an injection, so I am not sure if the SurgiCube would ever be cost-effective or rather make an expensive procedure even more expensive,” he said. – by Michela Cimberle
Disclosure: Pieramici reports he is a consultant for Genentech and does research for Genentech, Regeneron, Allergan, Alcon, ThromboGenics and Santen.