Stellaris PC Makes an Impact in the OR
Surgeons describe their overall satisfaction and make suggestions for further improvements.
Dr. Heier: What types of improvements would you like to see in the Stellaris PC (Procedural Choice) Vision Enhancement System (Bausch + Lomb) and in vitrectomy in general? What would you like the device manufacturers to develop further?
Dr. Blinder: I like how Bausch + Lomb has improved the trocar system for 23-g procedures with the Stellaris PC. They have made the blades solid rather than hollow to make insertion easier However, I have suggested that a valve system for the trocars would also be a great improvement and the company is presently working on this.
Dr. Antoszyk: I agree with Dr. Blinder about the improved trocar system not only for 23-g but also 25-g procedures. One big obstacle is visualization in a gas-filled eye due to glare and media opacities. The filtered lights on the Stellaris PC partially address this issue but significant cataracts or corneal opacities can impair a surgeon's ability to complete his tasks. An illuminated directional endoscope (25 or 23 g) would be very useful.
Dr. Kunimoto: Another suggestion for improvement, which also applies to vitrectomy units in general, is a 23-g fragmatome.
Dr. Wald: Does everyone here mainly use 23-g vitrectomy systems?
Dr. Antoszyk: I use 25-g about 95% of the time.
Dr. Wald: I use 25-g for every case. I have not used 23-g or 20-g systems in at least 5 years for any case.
Dr. Tewari: I have been using the Dutch Ophthalmics 23-g two-step system for a few years now and have been pleased with the wound construction. Like Dr. Heier, I make my incision with the angled 23-g blade, then load the trocars on the Dutch Ophthalmic metal inserters, which are reusable.
Also, I agree with Dr. Blinder that it would be beneficial to have valves. If not valves, then the cannulas could be more funnel shaped so that it would be easier to insert instruments into them. Another issue I have encountered with the Bausch + Lomb system is when I am unplugging the cannulas, there are times where I feel the entire cannula is coming out. The plug can sometimes catch on the inside of the cannula. I usually use a 0.12-mm forceps to hold the base of the cannula, but it would be better to have something more reliable.
Dr. Blinder: Sometimes I use the angled MVR blade to make a two-step incision before inserting a Bausch + Lomb cannula. Once I get the cannula in, I often clamp it instead of leaving it on. If I have a closed system, then I go ahead and use a regular Bausch + Lomb trocar, which seems to stabilize it better. I have not had any problems with wound leaks with the Bausch + Lomb entry system. They do not leak as much as some of the other one-step systems.
Dr. Heier: Maybe because I work a lot with Fellows and see a wide variety of referral patients from hours away, I have a very low threshold for using sutures. I tell our Fellows that while it is nice to be suture-free, there is no shame in putting in a stitch.
SUMMARY OF EARLY EXPERIENCE WITH THE STELLARIS PC
Dr. Heier: I would like to conclude with each of us summarizing our experience to date with the Stellaris PC and how it has impacted us in the OR.
Dr. Wald: Staff members find it simple to get up to speed with system setup, as well as make modifications while I am doing a case. The cutting system is obviously wonderful in that we can operate at 5000 cpm, have great control over the vitreous and not create too much turbulence at the retinal surface. With a wide range of cutting speeds, we can also dial down the speed quite a bit if a situation demands it.
Although I have not been using the system long enough to fully experience all of the illumination options, the ones I have used are excellent. Finally, the system is very good for doing combined cases with anterior segment colleagues. It is compact, good-looking and easy to set up.
Dr. Tewari: I have really enjoyed using the Stellaris PC. The key word for me is “control.” All of the control is in the surgeon's hands, from cut rates to coagulation to different modes, such as dual linear. All of these aspects can be controlled with the foot pedal. With that level of control, we can create improved stability in surgical situations such as retinal detachments and diabetic membrane dissections. This can help us achieve better outcomes for our patients.
Dr. Blinder: In designing and developing the Stellaris PC, Bausch + Lomb did its homework. The company took its time with this machine, so I has been engineered as an efficient, affordable, technologically advanced vitrectomy unit. I have enjoyed the high-speed pneumatic cutter. Our own experienced scrub tech gave her nod of approval when she said the system, while advanced, is very easy to set up for all technicians. It has been interesting to try the different light source modalities and filters, and I am sure we will have other uses for them as we gain more experience with the machine.
Dr. Kunimoto: In my opinion, this surgical system represents a significant improvement over the previous vitrectomy unit offered by Bausch + Lomb. The new cutter is lightweight and at 5000 cpm very efficient. The lighting system gives a lot of flexibility to the surgeon, and overall I think the system outperforms or can go head-to-head with any other equipment out there.
Dr. Antoszyk: It is hard to top the comments so far, but I see this instrument as thoughtfully engineered to be simple yet versatile, sophisticated yet pragmatic. The cutting system has been automated to maximize the duty cycle with varying aspiration, thereby enhancing the surgeon's control of cutting and minimizing the risk of inadvertent retinal injury. It is ergonomically designed and has a nice profile in the OR. It does not take up a great deal of space. The mercury and xenon light sources provide bright yet safe illumination, and the adjuvant filters enhance visualization of tissue planes, aid in reducing glare in gas-filled eyes and enhance the safety profiles of the independent light sources. I really like the cutter and the wireless foot pedal.
Dr. Heier: I could not agree more with everything that has been said. We were getting frustrated with our older machines, and Bausch + Lomb has really done well to deliver the Stellaris PC.
All of the newer machines capable of cutting at the 5000 cpm rate represent significant advances over what we had before and are enjoyable to use. They remind me of some of the other advances we have seen in recent years, such as spectral domain optical coherence tomography and the PASCAL laser (Topcon Medical Laser Systems) which made us enjoy doing panretinal photocoagulation again. The way I see the Stellaris PC is I am looking forward to using it in the OR again. I am confident we will see continued success with these and future advancements in vitreoretinal surgery. RP