Ambidextrous Phacoemulsification: A Right-Hand–Dominant Surgeon’S Journey To Left-Hand Proficiency In Topical Cataract Surgery

To describe the learning process, technical challenges, and early clinical outcomes associated with the transition of a right-hand–dominant surgeon to left-hand–dominant topical phacoemulsification, and to outline a reproducible framework for developing surgical ambidexterity.

A single-centre study conducted at a high-volume tertiary eye care facility in North India. All surgeries were performed by an experienced cataract surgeon in a routine clinical practice setting under topical anaesthesia between January and November 2025.

A prospective single-surgeon series of 60 eyes undergoing topical phacoemulsification performed with the left hand. Selected cases had nuclear sclerosis grade 2–4, good pupillary dilation, and no zonular weakness. A 2.2-mm superior-temporal clear corneal incision with two side ports enabled immediate right-hand conversion if required. Capsulorhexis was forceps-based and nucleofractis performed using direct chopping. Surgical time, conversion rate, and visual outcomes were analysed.

All 60 procedures were completed successfully under topical anaesthesia without major intraoperative complications. Mean surgical time was 8.5 ± 2.1 minutes. Conversion to right-hand surgery was required in 1 eye (1.7%) due to capsulorhexis runaway with suspected subtle lens subluxation. On postoperative day 1, UDVA ≥20/25 was achieved in 96.7% and UIVA (66 cm) ≥20/32 in 93.3% of eyes.

With deliberate bilateral simulation training, careful case selection, and strategic incision planning, a right-hand–dominant surgeon can safely and reproducibly achieve left-hand proficiency in topical phacoemulsification. Surgical ambidexterity reduces ergonomic strain and improves operative flexibility, particularly in high-volume and solo cataract practices.