UPFRONT: Straightening Out Retinal Surgery


“Organizing is what you do before you do something, so that when you do it, it is not all mixed up.” — A.A. Milne

As anyone who trains residents and fellows can attest, comprehension of the importance of taking a stepwise approach to surgery is paramount in one’s growth as a surgeon. Without fail, the description of any surgical technique in any textbook begins with positioning. Google “surgical steps” and the first page is filled with details on surgical positioning, not where one makes an incision.

Yet, without fail, I see patients entering the operating room with their head in the wrong position, their body not flat, and other issues with positioning that will make the surgery more difficult. Moreover, the fellows often adjust their own position to the incorrect head position contorting their body in the process. The adage that the surgery begins with draping is clearly evident here. Physicians in training often miss these easy details and then wonder why the eye is pulled up or why it seems so hard to reach parts of the eye during the vitrectomy.

Similarly, poor positioning of the patient is often compounded by poor setup of the operating microscope and surgical field. The arm rest may be too low or too high, requiring surgeons to contort their hands while operating, or the operating scope may be misaligned to the patient’s head, requiring surgeons to torque their backs. Little things can lead to long-term health consequences.

In this issue, we discuss ergonomics for retina surgeons, a topic we love to ignore until we come home sore. After a long day in the OR, positioning and field setup mistakes can lead to back and neck problems. Maybe some of the heads-up display or digital microscopes with 3D display will help alleviate some of these issues, but good posture is very important for a long surgical career. In addition, a strong core will help stave of these long-term health issues.

Clinic setup is also to blame, and this problem is highlighted in this issue. In some situations, it is difficult to change your exam room setup, but there are many simple techniques to make the ergonomics better. I hope our readers will enjoy this article as it may help with all those aches and pains! RP

Listen to episodes of Straight From the Cutter’s Mouth with discussion of Retinal Physician articles.