Official ESCRS | European Society of Cataract & Refractive Surgeons


Self-directed appraisal and refinement improves surgical efficiency in high-volume cataract surgery

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Session Details

Session Title: Combined Cataract Surgery & Practice Styles

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 15:40

Venue: Free Paper Forum: Podium 2

First Author: : M.Potter UK

Co Author(s): :    M. Bhogal   C. Wilde                          

Abstract Details


The 'Lean' and 'Six Sigma' principles are commonly used in manufacturing industries to eliminate waste, improve efficiency and enhance outcomes. We examined whether the application of these principles could be used to enhance surgical efficiency in routine high volume cataracts performed by a consultant in their first year if practice.


St Thomas' Hospital and Moorfields Eye Hospital


All cataracts performed on a high volume list were video-recorded and demographic data on patients, their cataract (LOCSIII) grade, biometry and comorbidity were recorded. A process map was constructed. Each time an instrument was picked-up or moved between hands was recorded using the surgeon's standard technique. 20 cases of un-complicated grade 2-3 cataracts were analysed. The surgical steps were streamlined to removed unnecessary steps and a further 20 cases were analysed. After streamlining, additional technique modifications based on the practices of well-recognised high-volume surgeons were evaluated, each in twenty cases.


The average time from the first incision to the removal of the drape was 7:52±35 mins for the surgeon's standard technique at the start of the process. Removing unnecessary steps and streamlining reduced the average surgical time to 5:32±24 mins (p<0.001, ANOVA). Adopting practises from high volume surgeons (Akahoshi instrument pass-back method and Devgan prolapse chop) reduced surgical time further to 4:10±34 mins (p<0.001). No intra-operative or post-operative complications were noted in any of the cases.


Consultant surgeons are increasingly being asked to deliver higher volume lists and enhanced efficiency. Having left a residency programme the onus for surgeons will be on self-directed improvement. We present a strategy by which surgeons can streamline their surgical steps with no risk of complications in the first instance. This was associated in a >25% saving in surgical time. After streamlining, modifications to the surgical technique can further improve surgical efficiency without any observed complications. At the end of the first year, average surgical time was approximately halved with no increase in complications

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