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N O V E M B E R 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
1
Have the right surgeons with the right
attitude. The surgeons you choose are ultimately going to
determine the success or failure of the center. Technical skill
isn't enough. There are some very good surgeons who still haven't
adapted and adopted new techniques. Retinal surgeons have to be
completely open-minded and have the discipline to learn new things
every day. That flexibility requires energy, discipline and a willingness
to step away from complacency.
There's no denying that speed is an important component of profitabil-
ity. But with surgeons, it's essential to understand and stress the differ-
ence between speed and efficiency. What's most important is having the
commitment to provide the best possible care for your patients. Patient
care must always be No. 1 and profitability always No. 2. As long as you
have those priorities set properly, you'll be on the right track.
2
Take advantage of increasingly precise
instruments and better visualization. With small-
incision vitreo-retinal surgery, we can use techniques that pro-
duce far less trauma and far better outcomes. We have 23- and 25
gauge instruments, and soon we'll have 27-gauge (the 27+ Portfolio,
recently introduced by Alcon). Since I prefer to use the smallest gauge
available, when the 27+ becomes available, I'll use that for all of my
cases. The smaller the wound, the better.
The smaller gauges also provide a smaller sphere of influence,
which reduces collateral damage, and increases the precision of your
dissection. With a 20-gauge instrument, it can be like using a vacuum
cleaner to pick up one M&M from a bowl that contains dozens — nor-
mal retina tissue is incarcerated with fibrous tissue. The smaller
gauge is like a small straw that lets you pick up one M&M without dis-
turbing the others. You can remove tissue in a much more precise
O P H T H A L M O L O G Y
