The Surgical Instruments That Keep My OR Humming

Our mission as retina surgeons is clear: safely and efficiently correct disrupted retinal anatomy such that it can heal. The reliability of the instruments in our hands partially dictates surgical success, and the engineers and innovators who design such tools have expanded their offerings and improved existing platforms with the goal of improving patient care. Surgeons and patients are the beneficiaries of such dedication.

Retina surgeons continuously strive toward a more perfect surgery, and considering new instruments is one way you may be able to improve efficiency, safety, and precision. If you’re curious about which instruments may fit into your OR, consider the following tools that have become mainstays in my surgical practice.

Not all membranes are created equal, and surgeons need a reliable tool that can handle membranes of multiple types.

The micro-serrated, broad grasping surface of DORC Ultra Peel Forceps allow me to address both fibrous and adherent membranes, and permit a firm grasp that results (in my experience) in less stripping of membranes during peels. This is particularly useful when training surgical fellows, who sometimes inadvertently shred membranes as they’re learning to master their technique.

The design of DORC Ultra Peel Forceps empower me to offer a safe surgery. The blunted, rounded tip of the forceps give me confidence that I will not induce iatrogenic damage via a pointed end that might nick retinal tissue beneath the membrane. Plus, given that my use of these forceps results in firmer grasping and less shredding, I require fewer passes over the retina—a risk reduction and efficiency improvement I’ll always opt for.

As my colleague David Xu, MD, has written elsewhere in this series, DORC EVA NEXUS users have access to a number of platform-based surgical benefits. Users will feel efficiency compounded when using DORC Ultra Peel Forceps on DORC EVA NEXUS. Such a double-dip might be just what your OR needs if you’re looking to boost efficiency.

We can only operate on what we can see. Innovators have successfully struck the difficult balance between proper illumination and safety, but it is up to us retina surgeons to reach maximum visibility without inducing phototoxicity. A pair of tools on my tray serve this purpose well.

The DORC Illuminated Curved Laser Probe and DORC TotalView Endoillumination Probe offer a one-two punch that has proven useful in my OR. When applying laser to peripheral tissue that might be difficult to visualize, use of a lighted laser applicator such as this one makes me more confident that I can illuminate all areas that need treatment. When evaluating and treating tissue in specifically difficult regions—for example, when treating a patient with a peripheral 12 o’clock break and positioning is complicated by trocar placement—use of the DORC TotalView Endoillumination Probe as a trans-scleral depressor allows me to bring tissue as close as possible to my DORC Illuminated Curved Laser Probe while also maximizing illumination.

I have found this combination of instruments to be uniquely useful when training fellows. I always want to prepare them for less-than-ideal scenarios, such as not having an assistant nearby to assist with depression. Using DORC Illuminated Curved Laser Probe and DORC TotalView Endoillumination Probe in concert reassures surgical trainees that they can assess anatomy by themselves while still adequately visualizing and treating diseased tissue.

The physics of retina surgery remain top of mind in the OR. Smaller spheres of influence and reduced chatter (ie, the reverberation of tissue near the mouth of a cutter) mean more precise and efficient surgeries, as well as a theoretical reduction in iatrogenic damage.

DORC’s most recent cutter, TDC VELOCE, reaches cut speeds of up to 20,000 cuts per minute (cpm). A noticeable reduction in tractional forces due to the mouth on DORC TDC VELOCE never fully closing means that my approach to the retina is more elegant and less disruptive. Further, improved aspiration flow compared with previous iterations of DORC TDC cutters mean faster vitrectomy times; specifically, aspiration flow rates are 14% and 26% higher, respectively, for the 25-gauge and 27-gauge instruments.

Importantly, DORC TDC VELOCE enables SMART IOP on DORC EVA NEXUS. With SMART IOP technology, surgeons access Valve Timing Intelligence pumps, which monitor IOP changes during surgery and adjust irrigation/infusion as needed. Surgeons thus spend less time worrying about IOP fluctuations and more time focused on the task at hand.

There are other important benefits to this next-generation vitrector:

• Increased staff stiffness empowers me to reach the periphery with confidence and to shave the vitreous base easily.
• An ergonomic dimple on the instrument’s shaft quickly and accurately orients the direction of the cutter when it’s in my hands. (Think of it like the bump on the f and j keys on a keyboard, which let you know where your fingers are without looking.)
• Reducing speed still leads to reliable cutting with DORC TDC VELOCE. When removing a hard material (e.g., a lens fragment), dropping to speeds as low as 1,000 cpm don’t sacrifice precision.

As we enter the new year, it may be time to evaluate opportunities to enhance efficiency, safety, and precision in your OR. Changes to instrumentation may be a pathway to elevate your surgical practice, and finding the specific tools that address your unique needs will be key to unlocking success.

^{The statements of the author reflect only his personal opinions and do not necessarily reflect the opinions of any institution with whom he is affiliated.
The author has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.}