The most valuable of all talents is that of never using two words when one will do.
Surgical maneuvers are akin to language and, like the Thomas Jefferson quote above, reminds us that succinct communication is always preferred. The same can be said for surgical procedures: Efficiency by means of eliminating redundancy is our manifesto, and here are two examples you can incorporate into your surgical cases right away.
Isolating rectus muscles
Whether you are looping muscles in preparation for placement of a scleral buckle or isolating rectus muscles for more advanced maneuvers like choroidal drainage, notice how I isolate the inferior rectus in the first video segment.
After I isolate the rectus muscle with a Green muscle hook and loop the muscle with a heavy silk suture, I slide the muscle hook backward and pull out the suture at the same time that I remove the muscle hook. This is very simple but speaks to constantly looking for opportunities to improve efficiency.
As the residents and fellows who work with me know, I’m obsessed with eliminating surgical redundancy. Never use two steps when one will do. Economical surgical
maneuvers will dramatically improve your efficiency in the operating room.
Next, we apply the same theme where I use one instrument instead of two for membrane peeling. For epimacular membranes, I favor a pinch-and-peel technique. However, with proliferative membranes in the detached retina, pinch-and-peel is sometimes awkward due to the presence of subretinal fluid, corrugations and/or folds in detached retina.
As you see in the second part of the video, you can use end-grasping (internal limiting membrane-style) forceps in the closed position and use the closed end to abrade membranes to release them from detached retina. This provides you with an easy technique to elevate a membrane edge. You can then grasp and peel in the usual fashion.
Although I’m a fan of the Tano diamond dusted membrane scraper and the Alcon Finesse Flex Loop, both of which can be used to initiate membrane dissection, you can also do this with end-grasping forceps in the closed position. This aids membranectomy efficiency without the use of additional instruments. RS