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‘Pop and chop’ yields shorter case times for residents than ‘divide and conquer’ technique
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Residents who used a “pop and chop” technique during cataract surgery were more efficient and their patients had similar complication rates compared to when a “divide and conquer” technique was used, according to a study.
In most residency training programs, the divide and conquer technique is taught as the initial method of nucleofractis. However, a pop and chop technique offered shorter case times and produced similar visual outcomes for patients when performed by residents, Fredric J. Gross, MD, told Ocular Surgery News.
“In our study, we concluded that pop and chop is a suitable technique for teaching novice surgeons how to perform cataract surgery. Based on our data and personal experience, we also believe that more practicing surgeons would benefit from adopting this technique in at least a portion of their cases. Studies looking at the safety and efficacy of transitioning experienced surgeons from divide and conquer to pop and chop or similar supracapsular techniques would be useful in better defining the role of these techniques in clinical practice,” he said.
Less time, less energy
Gross and colleagues evaluated 120 patients who were randomized to pop and chop or divide and conquer for their cataract surgery. The phacoemulsification procedures were performed by two residents, and the researchers evaluated each procedure for cumulative dissipated energy and case time.
Residents who used the pop and chop technique used on average less cumulative dissipated energy per case (8.6) compared with the divide and conquer technique per case (15.9) (P < .001). Additionally, on average the case time was 31.1 minutes for divide and conquer compared with 17.8 minutes for pop and chop (P < .0001).
Gross said the use of higher vacuum settings allows most nuclear fragments to be removed with less ultrasonic energy than with the divide and conquer technique.
The shorter case time for the pop and chop technique can be attributed to eliminating sculpting, which Gross said is “challenging for beginner surgeons who are unfamiliar with required depth or length of their sculpting grooves.”
The technique
Gross noted the pop and chop technique involves prolapsing the lens out of the bag during hydrodissection and using a standard size capsulorrhexis.
“Viscoelastic can be placed behind the lens for protection of the posterior capsule, but it is not necessary. A second instrument of the surgeon’s choice (straight or curved) is then introduced behind the posterior lens surface. The phaco handpiece is placed through the main wound onto the anterior surface of the lens. The two instruments are brought together, manually disassembling the lens into fragments that can then be removed with minimal or no phaco energy. The lens remains at the level of the iris plane or slightly anterior to protect the endothelium and prevent injury to the capsular bag,” he said.
The residents in the study used an Intrepid infusion sleeve and balanced tip (Alcon) with linear phaco energy of 50%, vacuum of 550 mm Hg and aspiration rate of 40 mL per minute, Gross said. – by Robert Linnehan
- References:
- Gross FJ, et al. Clin Ophthalmol. 2016;doi:10.2147/OPTH.S115840.
- Pop and chop: https://www.youtube.com/watch?v=3tFWlA0vxmI.
- Zero CDE pop and chop: https://www.youtube.com/watch?v=U3QVvmv_fiE.
- For more information:
- Fredric J. Gross, MD, can be reached at Department of Ophthalmology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980; email: heye5@aol.com.
Disclosure: Gross reports no relevant financial disclosures.