Working as an ophthalmic surgical tech can be very satisfying. When you have a good rapport with the surgeon, everything flows very smoothly. It can feel like a well-practiced basketball team executing a complicated play or a well-rehearsed ballet in which all dancers are exactly where they need to be at the right time. It’s a pleasure to be a part of such a well-oiled machine. In surgery, it helps to have an understanding of the procedure for which you’re assisting so you can anticipate the needs of the doctor — often without verbal communication.

This is especially true with cataract surgery, in which the team performs the same procedure time and time again. In this article, we’ll look at some basic approaches and philosophies for successfully assisting with cataract surgery.

Prioritize efficiency

First, it’s important to work quickly and efficiently when turning over an OR for cataract surgery. This is especially true in an ASC environment where a surgeon might work in two ORs, bouncing from one to the other. In that case, you might only have the length of time in which it takes a surgeon to complete a cataract surgery to clean up after the previous case and set up for the next one. For a fast surgeon, this could be five to 10 minutes.

The set-up

Let’s start at the beginning, with setting up the phacoemulsification machine. This entails draping the mayo stand attached to the machine then inserting the cassette and spiking the bottle or bag of irrigating solution. Next, you assemble the phaco handpiece, plug it into the machine, and attach the tubing. Now you can test and prime the handpiece.

Performing these steps first is important because it allows you to check for problems with the machine or handpiece early in the procedure. I often do all of this before the patient and surgeon arrive; they may become concerned if I find a problem with the machine, however unnecessary it might be. Usually, any problem is an easy fix, but a patient and even some surgeons might experience anxiety over words like “problem,” “error,” or “failure to prime.” Minimizing anxiety benefits all who are involved.

A good tech should always remain calm, cool, and collected as well. This can have a positive influence on all surgical team members as well as the patient and help lead to a successful surgery.

After setting up the machine, move your attention to the table of instruments and disposables. Many techs feel that laying out the instruments in the order of the procedure is helpful. It allows one to quickly find and hand off the appropriate item at the right time.

The procedure

From different instruments and equipment needs, to different techniques, and even occasionally the order of steps in the procedure, every cataract surgeon has different preferences. You might say, “There are many ways to skin a cat … aract.” However, the same basic steps are pretty much always there (see “Steps of a typical cataract procedure,” right). Most techs choose to lay out the instruments on the sterile field to accommodate this order.

After setting up the machine and table, you can drape the patient. By this time, the circulating nurse will have prepped the patient, usually with a povidone-iodine solution. Then, you — the tech — dry the surgical site and apply the sterile drape. Use good sterile technique, and pay attention to confirm the patient’s identity and the correct surgical site. After this, place the speculum, being very careful not to abrade the cornea.

Then, once the surgeon is gowned and gloved, you can both sit down to start the case. With your instruments laid in order, it’s very easy to flow from one step to the next. If the microscope you use has a set of oculars for the assistant, pay close attention through the scope. This way, you can be ready with viscoelastic if the ‘rhexis goes too wide, or with a Drysdale Nucleus Manipulator if a nuclear chip appears during the removal of the cortex, or for countless other possible scenarios. Your surgeon will greatly appreciate your ability to intuit his or her needs.

Conclusion

The tech is often the unsung hero of a surgical team, ideally blending into the background. A surgeon should be able to reach out his or her hand without even looking away from the microscope and expect the tech to place the appropriate instrument in his or her hand.

In this way, a tech is like the bass guitar in a song. You don’t always notice or pay attention to it, but without it the song just wouldn’t work properly. OP

Chris Joyce has been an Ophthalmic Surgical Technician for over 10 years. He works at Surgisite Boston in Waltham, MA. He’s also a performing musician and proud new father.