Aspiration Time As A Procedure-Specific Marker Of Technical Skill Acquisition In Resident Phacoemulsification

To evaluate the learning curve of resident-performed phacoemulsification surgery and to determine whether aspiration time reflects technical skill acquisition more specifically than total surgical time and other intraoperative parameters.

 Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey

This single-center retrospective study reviewed 167 uncomplicated phacoemulsification surgeries performed by residents between August 2025 and January 2026 under attending supervision using the same phacoemulsification system (Centurion®, Alcon). The residency program consists of five 2-month rotations. The first rotation was excluded due to minimal surgical case volume (approximately five cases per resident). Cases were analyzed across four rotations (R2–R5; n=38, 36, 35, and 58, respectively). Device-recorded parameters (total surgical time, aspiration time, ultrasound time, fluid usage, and CDE) were extracted. Kruskal–Wallis, Spearman, and multivariable regression were used.

Progressive improvement was observed across rotations. Total surgical time decreased from 27.9 ± 8.1 to 15.2 ± 4.3 min, aspiration time from 9.16 ± 2.32 to 5.78 ± 1.39 min, ultrasound time from 118 ± 52 to 75 ± 36 s, and fluid usage from 172 ± 52 to 102 ± 26 mL (all p<0.01). CDE remained stable (p=0.09). Aspiration time correlated negatively with rotation level (ρ=–0.51, p<0.001), with a plateau between the 3rd and 4th rotations (p=0.968). Effect size analysis showed a large impact of rotation level on aspiration time (η²=0.26). In multivariable regression (rotation + CDE), rotation independently predicted aspiration time (p<0.001), whereas CDE was not associated (p=0.28). The model explained 36% of the variance (R²=0.36).

The present study demonstrates a clear learning curve in resident phacoemulsification. Both total surgical time and aspiration time decreased significantly with increasing rotation level. While total surgical time showed the strongest correlation, reflecting improved procedural efficiency, aspiration time captured the active vacuum-control phase of surgery and remained independently associated with experience. In contrast, CDE showed no independent relationship. These findings suggest that aspiration time may represent technical skill acquisition more specifically than overall operative speed in cataract surgery training.