October 31, 2003
The concept of ‘slow surgery’ : New philosophy for decreasing endothelial cell trauma
OCULAR SURGERY NEWS EUROPE/ASIA-PACIFIC EDITION November 2003
The derivation of the name of slow surgery is slow life and slow food. The godfather of slow surgery is Yoshihiro Tokuda, MD, of the Inoue Eye Hospital in Tokyo,” Slow surgery is a campaign with the aim of the polite operation.”Slow surgery is not merely an abstract concept. Dr. Oki said that his concerns lie primarily with high flow and vacuum technology, which he suggested are the antithesis to slow surgery, both in action and in principle.“High flow and vacuum surgery aims at the efficient operation, but slow surgery aims at the safe operation,” High flow and vacuum levels are inherently unsafe because they create anterior chamber instability, Dr. Oki noted. When phaco is performed with high flow and vacuum, the turbulence that is created sets off a “dangerous” chain of events, he added.As the turbulence increases, viscoelastic is flushed from the eye, allowing the potential for nucleus fragments to collide with corneal endothelial cells and increasing the risk of injury to the endothelium, Dr. Oki explained. He said that the mean loss in endothelial cells is about 7% using high flow and vacuum technology, but a more important statistic is the potential for cell loss of more than 20%.Dr. Oki proposes that surgeons limit vacuum pressure to 150 mm Hg and flow rate to 20 cc/min. With lower vacuum levels, the rate of corneal endothelial cell loss can be decreased to about 2%, he said.Dr. Oki also expressed concerns about the phaco chop technique, which he said is also aimed at efficiency and not safety. He said proponents of slow surgery prefer the divide-and-conquer technique, which creates smaller nucleus fragments.
Posted by mehdi khanlari at October 31, 2003 02:05 PM