Part 2: The digital operating room

2.1 Digitalizing my cataract surgery workflow

Liem Trinh, MD

For several years, I have been taking advantage of the benefits of a digital workflow achieved by the connectivity between diagnostic and surgical technologies.

Video 1. My digital cataract workflow – Connectivity from diagnostic to surgery

The process begins with the automatic transfer of the biometry measurements obtained with the ZEISS IOLMaster 700 to the data management software (ZEISS FORUM). Using this software, I can conveniently perform IOL calculations remotely with our surgery planning tool - ZEISS EQ Workplace (see chapter 1 for more information). On the day of surgery, all the data required to perform the procedure are then seamlessly available at ZEISS CALLISTO eye in the operating room. ZEISS CALLISTO eye is therefore the integral component that connects my preoperative and surgical workflow (Video 1). Utilizing this digital data pathway in my clinic saves time and avoids transcription errors that can occur with manual data entry.

Figure 1. Addition of the ZEISS QUATERA 700 phacoemulsification unit to the cataract workflow creates a complete integrated platform for case management throughout the cataract patient journey.

The launch of QUATERA® 700 from ZEISS added another component to my digital operating room suite and brought it into a new era. By centralizing data communication within the OR, ZEISS QUATERA 700 creates a complete system for connectivity and further enhances our workflow efficiency (Figure 1).

ZEISS QUATERA 700 is a next generation, digitally connected phacoemulsification system that serves as a complete surgical cockpit and puts all the information I need during a procedure at my fingertips (Video 2). The phaco machine’s screen displays patient data, including patient name, date of birth, and planned IOL. Having convenient visual access to this information eliminates the need for printouts in the OR and therefore avoids situations of having the wrong documents or missing sheets.

Video 2. My digital OR cockpit

ZEISS QUATERA’s screen also shows the live video from the surgical microscope, which allows OR staff to follow the progress of the operation in real time and anticipate my need (Figure 2). Thus, my surgical nurse can anticipate my need for a particular instrument or the IOL and have it ready to give to me, saving time.

Figure 2. ZEISS QUATERA 700 serves as a surgical cockpit, integrating patient data, displaying the live surgical video, and connecting to ZEISS CALLISTO eye.

Through connectivity between ZEISS QUATERA 700 and my microscope’s CALLISTO eye, the phacoemulsification parameters are simultaneously displayed on my surgical microscope view. Therefore, I am able to adjust parameters in real time while maintaining my focus through the microscope because I do not have to look away at the ZEISS QUATERA 700 screen.

There is also connectivity between ZEISS QUATERA 700 and ZEISS CALLISTO eye that allows me to control CALLISTO eye’s assistance functions myself using the phaco device’s foot pedal. This connectivity allows me to stay focused on the surgery without having to look at the screen or be talking to and depending on staff.

Conclusion

In my opinion, the digital connection of diagnostic and surgical technologies can optimize patient outcomes and clinic efficiency by streamlining workflow and ensuring data accuracy during cataract surgery. The addition of the ZEISS QUATERA 700 has taken digitalization and efficiency in my clinic to a new level. With the next generation phaco device, I now have a fully connected surgical cockpit that has raised my experience as a surgeon to a new level at the service of the patient journey (Video 3).

Video 3. Conclusion

2.2 Benefits beyond digitalization

Miguel Amaro, MD

Operating in a digitally connected environment enables cataract surgeons to achieve the best outcomes and happy patients. However, the technical performance of the tools we use is also a critical factor.Therefore, I appreciate working with ZEISS QUATERA 700 that addresses both needs. In addition to introducing a new world of capability through serving as a surgical cockpit, ZEISS QUATERA 700 is engineered with innovative technology for both fluidics control (QUATTRO Pump®) and ultrasound management (Power on Demand) that I believe have benefit for increasing both surgical safety and efficiency in my clinic (Video 4).

Video 4. Combining latest phaco technology with the opportunities of connectivity and data access

Anterior chamber stability

Although there has been an ongoing evolution in the design of phacoemulsification devices with the aim of optimizing fluidics control during cataract surgery, anterior chamber and IOP instability can still occur. The patented QUATTRO Pump is a unique fluid exchange system designed to address this issue.

The QUATTRO Pump is a synchronized fluid-exchange system that represents a new category of phacoemulsification pumps (Figure 3). It is neither a flow-based (peristaltic) nor a vacuum-based (Venturi) pump, but it brings the best of each of those systems by providing the higher attractability of a Venturi pump and the control of a peristaltic pump. Unlike traditional phaco systems, the QUATTRO pump also directly controls infusion.

The new fluidic system consists of two pumps for irrigation and two pumps for aspiration that provide reciprocal exchange of infusion and aspiration fluids (Figure 3). Irrigation and aspiration volumes are directly measured, and the pump system allows accurate calculation of leakage volume so that it provides real-time fluidics compensation and can maintain target IOP, even if leakage is high. Independent of vacuum limit or level of IOP, recovery of target IOP occurs nearly instantly, as low as 200 ms (data collected by Carl Zeiss Meditec).

Figure 3. The ZEISS patented QUATTRO pump

The performance of the QUATTRO Pump for controlling fluidics was demonstrated in a laboratory study that evaluated management of IOP versus aspiration flow rate and incision leakage rate using a peer-reviewed spring-eye model. Results of this in vitro study showed that compared to a competitor’s phacoemulsification machine, ZEISS QUATERA 700 was associated with a shorter duration of surge after occlusion break regardless of vacuum and aspiration flow rate settings and thus maintained better chamber stability.¹

But what does all this mean for our daily work as cataract surgeons? I think all surgeons would agree that maintaining a stable environment is crucial for safe and successful cataract surgery. There are many good phacoemulsification devices available on the market. What is different for me using ZEISS QUATERA 700 is that I feel there is absolute stability, and so for me, concern about surge is a past theme.Therefore, I have the confidence to operate with fairly high flow and high vacuum levels. Consequently, I benefit from high attractability that allows me to operate with efficiency as well as safety. Because the fragments come to the tip, I can keep the phaco tip in the center of the anterior chamber where it is away from the capsule and iris. The attractability and stability provided by operating with ZEISS QUATERA 700 and its QUATTRO Pump can be especially seen in challenging cases, such as in eyes with wider than planned incisions associated with a history of radial keratotomy, fragile zonules, dense cataract or intraocular floppy iris syndrome (Video 5).

Video 5. Experiencing attractability, followability, ultrasound modulation and stability in cataract surgery

Ultrasound management

ZEISS QUATERA 700 has another feature that I believe further supports cataract surgery safety and efficiency, especially for surgeons who are early in their career and still developing their skills, and that is its technology for ultrasound management. Because QUATTRO Pump continuously measures fluid inflow and outflow, it can also detect occlusion and occlusion breaks. The latter capability is the foundation for QUATERA 700’s automated ultrasound management system – Power on Demand.

Power on Demand activates ultrasound only when the phaco tip is occluded and switches it off automatically as soon as the occlusion clears. Because activating ultrasound only when it is needed both minimizes total ultrasound energy use and enhances attractability, Power on Demand, in my opinion, represents another opportunity for augmenting cataract surgery safety and efficiency.

Conclusion

I am appreciating the stability and efficiency I am experiencing using ZEISS QUATERA 700 for cataract surgery. In addition, I see that this latest generation phacoemulsification system provides immense value through its digital integration and connectivity with the ZEISS Cataract Workflow that gives “live” control of all parameters and immediate access to biometric and anatomical data that are essential for case success. With its technologies for fluidics and ultrasound control and capability for enhancing workflow, ZEISS QUATERA 700 is increasing efficiency and safety in the demanding environment of my high volume cataract surgery clinic

Reference

1. Fanney D, Layser GS, K AR, Kohlhammer S, Kübler C, Seibel BS. Experimental study comparing 2 different phacoemulsification systems with intraocular pressure control during steady-state flow and occlusion break surge events. J Cataract Refract Surg. 2023;49(9):976-981.

Supported by ZEISS
The statements of the authors reflect only their personal opinions and experiences and do not necessarily reflect the opinion of any institution with whom they are affiliated with. The authors alone are responsible for the content of their experience reported and any potential resulting infringements. Carl Zeiss Meditec AG and its affiliates do not have clinical evidence supporting the opinions and statements of the authors nor accept any responsibility or liability of the authors’ content.
The authors Liem Trinh and Miguel Amaro have a contractual or other financial relationship with Carl Zeiss Meditec AG and its affiliates.

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