How Advanced Vitrectomy Components Impact Surgical Efficiency
V-LOCITY® Efficiency Components aim to optimize performance and minimize complications.
GEORGE A. WILLIAMS, MD
The CONSTELLATION® Vision System (Alcon Laboratories Inc., Fort Worth, Texas) provides vitreoretinal surgeons with a host of technological features designed to optimize surgical performance and efficiency while minimizing complications. These features include:
► Improved pneumatics, allowing high-speed cutting up to 5000 cpm and surgeon-controlled duty cycle at any cut rate
► Optimized port design to enhance tissue removal and dissection
► Integrated pressurized infusion and intraocular pressure (IOP) control, which allows the system to constantly regulate infusion pressure and control IOP in real time within a 2 mmHg tolerance, resulting in more stable IOP
► Improved xenon illumination for enhanced visualization
In aggregate, these features offer the surgeon better control over the surgical arena.
Time is one of the surgeon's most precious resources, yet it is also the resource that the surgeon controls the least. Any system that enhances surgical efficiency is valuable in the current era of declining reimbursement. The CONSTELLATION® Efficiency Components, termed V-LOCITY®, are designed to optimize operating room setup, enhance the surgical experience, and increase productivity.
|George A. Williams, MD, is chair of the department of ophthalmology at William Beaumont Hospital and director at Beaumont Eye Institute in Royal Oak, MI. Dr. Williams is a consultant for Alcon Laboratories, Inc., Fort Worth, Texas.|
MORE EFFICIENT SETUP
The V-LOCITY® Efficiency Components that come into play preoperatively include a bar code reader, ENGAUGE® radio frequency identification device (RFID) technology, embedded Video DFUs for improved setup, an articulating tray arm, and integrated pressurized infusion. Together, these features facilitate more rapid setup for each operation.
The bar code reader scans the operative pack or other consumables during the case to input critical information into the system. This informs the system which equipment is being used so the scrub/circulator does not have to manually select each device on the setup screen. In addition, the system can keep track of consumables used during a surgical procedure for inventory analysis.
ENGAUGE® RFID automatically recognizes the type of device being connected to the machine. If the scrub accidentally attempts to connect a device to the wrong port, RFID will signal the user via different colored rings around the port that a different port is required. ENGAUGE® RFID also populates the proper probe and gauge size into the system, which further facilitates setup.
An increasingly common problem in vitreoretinal surgery is the shortage of qualified surgical personnel. This means that surgeons often must rely on inexperienced technicians for equipment setup and support. The CONSTELLATION® Vision System has embedded video DFUs, featuring text and video instruction, that help even inexperienced support staff set up the system quickly and accurately.
The articulating tray arm allows the system to be set up and primed before the patient enters the room. It is no longer necessary to wait for the patient to be positioned before instrument setup is completed. This greatly improves turnover time. The articulating tray arm has multiple degrees of motion, which allow it to be positioned over the patient during surgery.
The advanced fluidics of the CONSTELLATION® system provide integrated pressurized infusion. The infusion solution is now metered directly from the cassette in the system, and not the hanging bottle. This feature eliminates the need of the long snorkel required when metering solution from the bottle, which was a challenge for some circulators to setup. This also means that the bottle fluid level does not need to be calibrated to the level of the eye. Another advantage of integrated pressurized infusion is that it allows push-priming so that lines and instruments are primed from the machine outward. This eliminates the need for aspiration of fluid into the cassette and provides for easier setup that saves significant time. The advantages of push-priming over aspiration are particularly apparent with 25-gauge instrumentation, where conventional priming can take upwards of two minutes while push-priming takes approximately 10 seconds. The status of the priming process and instrument testing is displayed on the graphic user interface of the console.
The auto-infusion valve of the CONSTELLATION® system allows the surgeon to independently switch back and forth between air and fluid infusion, avoiding the often confusing maneuvers associated with the stopcock. This valve can be activated from the foot pedal or from the graphic user interface of the console.
Another intraoperative enhancement is the auto gas fill capability. The CONSTELLATION® Vision System can deliver either C3F8 or SF6 gas directly from the front of the console. The respective gases are stored in tanks affixed to the back of the machine. This system allows the entire process to be performed by the scrub tech, and avoids the difficulties and potential contamination associated with transferring gas from outside the sterile field. The system fills the syringe with undiluted gas in less than 1 minute (depending on the number of purge cycles requested) and it can be performed without interrupting other console tasks. Also, the system provides a gas concentration calculator to aid the scrub in calculating the correct dilution for the desired gas concentration. A safety feature on the gas syringe helps differentiate pure gas from diluted gas.
The CONSTELLATION® Vision System also has an embedded laser system, PUREPOINT®, which can be controlled from the graphic user interface. The laser can be set up by the scrub tech, thus avoiding potential contamination. The system has 2 laser ports to allow for endo and indirect ophthalmoscopic capability. The surgeon also can control the laser parameters via a multifunctional laser foot pedal.
A new intraoperative feature is proportional diathermy, which allows the surgeon to increase diathermy independently from the scrub tech. By depressing the foot pedal, the surgeon can increase the diathermy intensity linearly. The diathermy uses a higher frequency (1.5 MHz), which allows for more confined and precise treatment. As with the previous generation of this technology, a microreflux provides short duration pressure to relieve incarceration from the suction port. A new feature is proportional reflux, which allows the surgeon to create a proportional reflux stream up to 120 mmHg. This feature is particularly useful for displacing hemorrhage from the retinal surface. Both reflux properties are controlled by the surgeon via the foot pedal.
The integrated pressurized infusion with IOP control also provides enhanced safety. The machine notifies the surgeon when the infusion bottle is low or out. Perhaps most importantly, the system allows the circulator to change the bottle without the need to stop the operation and close the infusion to the eye. Experienced surgeons will readily recognize the advantages and safety implications of this feature.
Postoperatively, the CONSTELLATION® Vision System provides a detailed analysis of the operation, including laser metrics, case metrics such as fluidics, vitrectomy and fragmentation times, and parameters including consumables used and a customizable operative record form. These forms can be printed on a wireless printer for postoperative documentation.
The V-LOCITY® efficiency components of the CONSTELLATION® Vision System are designed to enhance surgical capability, safety, and productivity. They are welcome advancements in our quest for increased productivity and optimal outcomes. RP