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Making Phaco More OR-friendly
These machines' innovations assist your staff as well as your surgeons.
David Bernard
Publish Date: March 17, 2008   |  Tags:   Ophthalmology

According to the leading manufacturers of cataract phacoemulsification units, the features that make their equipment easy, efficient and ergonomic are nearly as important as the technology that drives the phaco process itself. Here's an overview of some of the OR-friendly elements in the latest phaco machines that their makers say optimize their use for members of the surgical staff as well as for the cataract surgeon.

Rationale for accessibility
"In today's surgery, the expectations and the success rate are high," says Pat Hassett of Alcon Laboratories, which markets the Infiniti Vision System. "Everyone's looking for things to go as smoothly as possible, and all of that depends on the routine. There's a lot of thought that goes into the equipment to make it easier to use."

"For a busy OR, what we have added can help with turnover and training," says Jeff Martin of Advanced Medical Optics, which manufacturers the Whitestar Signature Phacoemulsification System. "The easier you can load and unload tubing, the better, [and] the software is designed to make a safer environment for the doctor and the OR staff."

Chuck Hess of Bausch & Lomb agrees. "That's really what the Stellaris Vision Enhancement System was meant to do, to be straightforward and user-friendly," he says. "A number of things were done with Stellaris to increase the ease of use."

But, as Cam Cameron of American Optisurgical, the maker of the Vizual Phacoemulsification System, points out, each of the currently available products have a lot in common. "Almost all the machines function the same way — irrigation, aspiration, phaco," even the features making them easy to use, he says. "Your choice often depends on marketing factors."

Service situations
In the field of phaco machines, Alcon is generally regarded as the market leader. While its Infiniti Vision System relies on technical innovations to make it easy to work with, the company also touts its service and support.

"A big part of what makes [the system] user-friendly is the people behind it," says Mr. Hassett. "The sales reps in the field are dedicated to working with and training staff. It's not in the software, but that's an essential benefit, and I don't think there's any way to lose sight of that fact."

Bausch & Lomb's Stellaris offers an option that can make service automatic. Its TruLink Customer Support Network not only captures surgical data and backs it up in a Bausch & Lomb database, it also regularly monitors the system's performance — like an automobile's remote tracking system — and alerts users to needed maintenance and upcoming service milestones.

Mr. Cameron says the design of American Optisurgical's Vizual was inspired by medical equipment's need for service. Compared to other phaco machines, Vizual is compact at 22 pounds and about two times the size of a notebook computer. Its portability and fold-down screen make it easy to store and transport for small ASCs and traveling surgeons, and easy to ship if service is needed. "It's got a lot of high-end features in a small package," he says.

Viewing and interacting
If the eyes are windows to the soul, then display monitors are windows to the progress of a surgical procedure. Each manufacturer offers large, color, flat-panel display monitors for surgical staff visibility and coordination. Alcon notes that its screen tilts and rotates 180 degrees on two axes for accessibility.

Each unit also uses a touchscreen to its advantage for a graphical user interface. AMO, for instance, touts the benefits of one-touch access to all settings on its Whitestar Signature system. On American Optisurgical's Vizual, a user can raise or lower an IV bottle on the system's optional automated pole by moving an icon up or down the screen with her fingertip.

B&L highlights the fact that the function icons for Stellaris's interface can always be found in fixed locations on the display screen to facilitate user orientation and control. "When they're under the gun to change parameters, they can easily do it," says Mr. Hess. "The nurse knows exactly where to look ??? and consistency breeds reliability."

The Stellaris's high-definition display screen also offers, as an additional option, a built-in video viewer that streams a real-time view of the ongoing surgery. The viewer, formatted as an inset window so the system's parameters and settings are simultaneously accessible, lets the OR staff see what the surgeon sees without cluttering the surgical space with more monitors.

Each manufacturer's phaco system also includes onscreen help and support, whether in the form of a technical users manual or a video tutorial, to provide images and animations to guide users through the system's installation, setup and surgical operation.

Console configuration
While B&L's Stellaris isn't nearly as compact as the American Optisurgical Vizual, it boasts the smallest footprint in its class at 17.62 inches wide by 17.89 inches deep and is 63 inches from the floor to the top of the bottle hook when the pole is fully retracted. B&L also promotes its single-foot locking mechanism, which brakes all four wheels in one step.

In the interests of efficiency, visibility and ease of reach, Alcon, AMO and B&L each feature front-loading tubing cassettes and front-loading connections for accessories. With front access in the sterile field, the manufacturers explain, a surgeon's assistant can quickly set up for surgery, see what accessories are in the machine and deftly manage handpiece connections.

B&L's Stellaris features illuminated accessory connections for dimmed ORs, an automated IV pole that's accessible from four locations — the pole, the console, the foot pedal and a remote control — and an instrument tray that pulls out of the console and elevates to the desired level.

The instrument tray on Alcon's Infiniti Vision, also height-adjustable, can swing around like its display screen, allowing the surgeon not only the flexibility to use it on either side of the patient when switching eyes, but also while seated either above or alongside the surgical site.

Setting up
"In a busy OR, especially in a one-OR facility, you're limited by how quickly you can turn over a room," says AMO's Mr. Martin.

For a caseload of cataract procedures, that turnover includes priming and tuning the phaco machine to check and calibrate the system's hardware and software before each case. "Everyone waits on that cycle to complete. It can slow you down," he says. That's why AMO highlights the one-touch prime/tune cycle on its Whitestar Signature unit. At about 20 seconds, says Mr. Martin, it's the fastest cycle on the market, compared to the average cycle of about a minute.

AMO's Whitestar allows up to 32 surgeons to save their personal settings in the system, a benefit for the staffs of centers that host multiple surgeons. It also includes a USB port, letting surgeons save their settings onto a memory stick and upload them to any Whitestar Signature system, a benefit for surgeons that visit multiple eye surgery centers.

One of American Optisurgical's chief selling points in terms of the Vizual system's setup is the reusability of its tubing cassettes, phaco tips and other consumable components, says Mr. Cameron. Tubing cassettes, for instance, generally cost $20 or more, he says. However, flushing out the side-loading, reusable cassettes for as many as 40 uses represents a significantly lower cost per procedure.

Command and control
"The biggest issue a nurse faces in the operating room is cord management," says B&L's Mr. Hess. To that end, his company's system, as well as Alcon's and AMO's, offer wireless foot pedals that can be placed and moved anywhere on the OR floor to suit surgeons' comfort. Their settings can also be individually programmed to allow a surgeon to define which foot movements will result in which actions.

Wireless remote controls, available with the above-mentioned systems, also let surgical staff change a system's settings from anywhere in the OR. The buttons on Alcon's remote control are backlit for use in dimmed ORs, and their layout is designed to resemble the location of the same functions on the machine's touchscreen.

While voice-activated phaco systems are not yet available — although AMO's Mr. Martin forecasts their eventual arrival — the AMO Whitestar Signature and B&L's Stellaris both feature optional voice confirmation that the surgeon's requests have been acted upon. A system that audibly confirms it's in phaco or irrigation/aspiration mode comes in handy, says Mr. Hess, when the surgeon's eyes are fixed on the microscope.

Scrub sink message
The point of OR-friendly features in phaco units is accessible use for more control, resulting in increasingly efficient case volume. "What is the overall message, the ???scrub sink message,' of what our system offers?" asks AMO's Mr. Martin. "It's that surgeons can choose the parameters of how they want to do their surgeries. The added ease-of-use features help them to do things quickly, and in the manner they want."

Phaco Units At-a-glance

Advanced Medical Optics
Whitestar Signature
Phacoemulsification System
(877) AMO-4LIFE
List price: not disclosed
FYI: AMO's Whitestar Signature System is an all-new surgical platform representing a breakthrough in safe, easy lens removal technology, says the company. Only the Whitestar Signature System combines the safety of revolutionary Fusion Fluidics with the optimized cavitation of Whitestar Technology. The integration of these technologies offers cataract surgeons the versatility needed to remove both hard and soft lenses.

Alcon Laboratories
Infiniti Vision System
(800) TO-ALCON
List price: $99,800
FYI: Alcon's Infiniti Vision System combines unparalleled fluidics with unique energy delivery systems to provide customized treatment for each patient, says the company. The proprietary OZil Torsional Handpiece delivers controlled, side-to-side oscillating, ultrasonic movement to efficiently remove cataracts of all densities with virtually no repulsion, providing a level of followability that dramatically alters how surgeons can perform phaco.

American Optisurgical
Vizual Phacoemulsification System
(800) 576-1266
List price: starting in the low $20,000s
FYI: American Optisurgical's Vizual Phacoemulsification System provides complete anterior cataract functions, including irrigation, multi-modulation phacoemulsification, micro-phaco, burst mode, irrigation/aspiration, anterior vitrectomy and bipolar coagulation. The system features a large, color, foldable LCD touchscreen with user-friendly controls, a large selection of user programs, reusable or disposable tubing using an easy-loading, non-invasive tubing cartridge and an ultralight, four-crystal handpiece. An optional automated IV pole is available.

Bausch & Lomb
Stellaris Vision Enhancement System
(800) 338-2020
List price: $125,000
FYI: Bausch & Lomb's Stellaris Vision Enhancement System is customizable for either vacuum or flow-based fluidics and is ergonomically designed for optimal efficiency and ease of use, says the company. The system features industry-leading innovations and is designed to empower surgeons to optimize their surgical technique of choice, from standard coaxial to advanced sub-2mm coaxial or bimanual microincision surgery.