Book Reviews with step-by-step instructions on 27-Gauge Vitrectomy

Ask any vitreoretinal surgeon what the future holds, and the answer is always the same: “Smaller!” Smaller gauge, that is, and its promise of smaller incisions, shorter surgical times, fewer scleral sutures, less inflammation, and hopefully a faster and smoother recovery. But how and when should each surgeon decide to transition from 23G? Which points must be taken into consideration? How does one get started? The textbook 27-Gauge Vitrectomy (Springer), by Ulrich Spandau and Mitrofanis Pavlidis, is a great place to start. As promised, it provides “step-by-step instructions on how to operate with 27G instrumentation in a wide range of surgical indications… and a meticulous description of preparation and performance with supporting photographs, drawings and videos.” In doing so, it does a thorough job of preparing a surgeon for the upgrade to 27G surgery. But this book is not simply a tribute to 27G. Instead, it is a rather comprehensive handbook of surgical technique, offering experienced insight into the instruments, procedures and principles of vitreoretinal surgery as it is currently practised. While watching many of the 103 videos (convenient to download, with titles such as ‘Anterior dislocated IOL and macular hole with 27G’), reading all 101 surgical pearls (such as 'Difficult IOL extraction from posterior pole'), and contemplating the 35 case reports, I had the pleasant feeling that I was back in my fellowship, being actively coached through an operation. This book is most appropriate for vitreoretinal surgeons planning a switch to smaller-gauge instrumentation, as well as for VR fellows and early-career VR surgeons. 27G CHALLENGES Once the switch to 27G has been made, several challenges will arise. One of these is the management of difficult diabetic retinopathy cases. Ever since the development of smaller-gauge techniques, surgeons have expressed reservations about the ability of these much thinner instruments to handle long, complex procedures involving a great deal of manipulation of the globe. Is the vitrectome rigid enough? Is the aspiration powerful enough? Will my surgery take forever? Small-Gauge Vitrectomy for Diabetic Retinopathy (Springer), by Ulrich Spandau and Zoran Tomic, puts these concerns to rest. “All gauges from 20G to 27G can be used. The main limitation of 25 or 27-gauge is the limited product range of vitreoretinal instruments. This will most likely change in the future,” the book states. The text then proceeds to share the surgeons’ experience and insight regarding the step-by-step treatment of every classification of proliferative diabetic retinopathy. Intended readers are the same as for 27-Gauge Vitrectomy.

Tags: retinopathy, vitrectomy