How to conquer your first solo phaco

Key Points

The odd part is that you, the boss, are in an unfamiliar environment-as if you are cooking in someone else's kitchen-and the staff, your subordinates, are in their usual place. They will be trying to figure out who you are and what your relationship with them will become.

In this unusual predicament, the critical factors remain the common goals: the care and respect bestowed on the patient and the commitment to obtaining the best possible outcome. There is no place for cynical, business-as-usual attitudes (which are found in some operating rooms) in today's environment of refractive cataract surgery and presbyopia-correcting IOL implants. Here are 10 steps to conquering your first solo phacoemulsification procedure.

An average scrub nurse hands you the right instrument when you request it. A good scrub nurse hands you the instrument you need, not necessarily the instrument you request. A great scrub nurse has the right instrument waiting for you before you even have thought of what you need.

The middle of your first phaco is not the time to assess the competency of the staff. Get to know the staff members, and their levels of education and expertise, before you set foot in the OR. It is possible to succeed with poorly educated people, but it requires a great deal more direction from you.

Holding a firm rein will go a long way toward maintaining efficiency; however, a calm and confident demeanor is necessary to avoid ruffling feathers during your first surgical days. If something is not going the way you want, look within yourself to find the fault. That's probably where it is. Communicate your needs and expectations to the staff; if they are pulling for you to succeed, they will appreciate direction to help you to get there.

2 Know your equipment. Do you know your phaco parameters? Several years ago, I was invited to perform live surgery for a conference in India. I examined my first patient at the slit lamp a few moments before walking into the operating room. He had 4+ nuclear sclerosis, and I knew that a thousand Indian cataract surgeons would be watching my every move. I gave the circulating nurse a piece of paper with my phaco settings. I had brought my own instruments and spent some time instructing the scrub nurse, through a translator, about the order in which I would need them.

The patient then was draped on the table (we had to use autoclaved saline in a glass milk bottle to wash), and as I adjusted the microscope I noticed that the phaco machine had not yet been set up.

Just then, a deep voice spoke into my ear, "Give me your parameters." I said, "Who are you?" The voice said, "I am Alcon India." I looked around and saw the man to whom I had given my piece of paper. "Where's that paper I gave you?" I asked. He pointed to a shelf on the wall where he had dutifully deposited my parameters. Alcon India took a look at the paper and nodded gravely. "Yes," he said, "these will work."