Executing your first cataract surgery on a real patient as the primary surgeon is a monumental occasion. The ball of nerves in your stomach will start winding weeks in advance. It’s what you’ve been waiting for, striving towards, excited for and yet the weight of “first, do no harm” rests heavily. Follow these tips to fulfill your sacred responsibility to your patient and to become a surgical superstar.
1. Pre-Op Routine
Sign all the pre-op orders for your upper level. It’s not “scut work.” It’s preparation for your first case. Listen carefully to their consent talk, including intra and post-operative expectations. Delivering this talk with confidence will reassure your patient.
2. Position Carefully
Every detail matters. Wheel the bed into the operating room head first, locking it exactly where the scope can reach the patient’s eye. Tape their head with the orbital rims parallel to the ceiling. Drop the foot of the bed several inches to prevent posterior pressure on the globe. The bed height should allow you to sit comfortably in your chair with shoulders dropped (important to prevent shaking), elbows bent and fifth fingers resting gently on the patient’s forehead and cheek. This technique prevents complications when the sedated patient randomly moves as your hands will move with them. Avoid numb legs by lowering your chair so you aren’t sitting on its edge to reach the pedals. Dial your pupillary distance (PD) into the microscope, ensure each ocular has your prescription, and “zero” or center the scope. While looking through the oculars, bring the scope down to the patient’s eye. Stop lowering it as soon as the patient’s eye comes into focus. Focusing in too far will give you a headache.
3. See One
Memorize every step when observing your upper level operate. Request a copy of their dictation to learn the names of the steps and instruments. Then dictate for them. Obtain the cataract instrument list and learn the phaco machine set-up with trouble-shooting tips from your esteemed scrub nurse. Show your nurses respect as they can teach you volumes.
4. Do One
Don’t expect to operate immediately. Most upper levels are nervous at the beginning of the year as they are still learning. In the meantime, organize sessions in the wet lab accompanied by an attending or fellow. Their time is precious, so memorize tip 3 before the wet lab. Practice suturing and cataract surgery steps on pig eyes. As your upper levels gain confidence, they will let you do parts of their cases. Draping, placing the lid speculum and making the paracenteses and main wound are small but hugely important steps. Performing these steps prior to your primary cataract surgery lends a fantastic advantage for learning positioning and working under the scope.
5. Teach One
Lastly, remember where you are now when you become an upper level. Honor the gift your upper levels, fellows, and attendings gave you by teaching your first and second years. If you are good to them, they will be good to you. Pay it forward.
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About the author: Natasha Herz, MD, is a cataract, corneal and refractive surgeon who works as a solo practitioner at Kensington Eye Center in Washington, D.C. She completed her residency and fellowship at the Cullen Eye Institute at Baylor College of Medicine in Houston. Local peers selected her to appear in Washingtonian magazine’s Top Doctors of 2014. She also is the vice president-elect of her local medical society and chair of the YO Info editorial board.