By Ulrich Spandau, Mitrofanis Pavlidis
This ebook offers step by step directions on how one can function with 27G instrumentation in quite a lot of surgical symptoms, together with vitreous floaters, macular holes, dropped nucleus, retinal detachment, diabetic retinopathy, submacular hemorrhage, retinopathy of prematurity and lots more and plenty trauma. All surgical procedures are approached in cookbook type, with preliminary insurance of the “ingredients” (devices and tools) after which meticulous description of practise and function with helping images, drawings and video clips. furthermore, the variations and merits compared to 23G and 25G vitrectomy are highlighted.
Small-gauge vitrectomy has notably replaced the ways that vitrectomy is played. 27G vitrectomy is the latest and most enjoyable improvement in small-gauge vitrectomy. The therapeutic time is quicker however the small diameter prolongs the length of surgical procedure. This drawback has been triumph over with robust new vitrectomy machines and innovative vitreous cutters with slicing blades making 27G vitrectomy as quick as 25G. This new gear has elevated the indicators for 27G surgical procedures immensely from detachment surgical procedure to retinopathy of prematurity and the arrival of recent tools may possibly make 27G the optimal sooner or later. This ebook, written via authors with large event in 27G vitrectomy, will let surgeons to totally make the most its advantages.
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Extra resources for 27-Gauge Vitrectomy: Minimal Sclerotomies for Maximal Results
An external light source such as Brightstar (Fig. 3) (DORC) or Photon (Alcon) provides more brightness than an internal light source. An alternative to an external light source is the internal light source of the newest generation of vitrectomy machines such as EVA (DORC), Stellaris PC (B&L) and Constellation (Alcon). The EVA machine has an integrated LED light (Fig. 1). Their internal light source is as powerful as an external light source. (3) Choice of chandelier light. The brightness of chandelier lights varies a lot.
3 Devices 19 And again: It is worthwhile to set high standards regarding visualization because it influences the surgical quality and outcome directly. 2 Operating Room (Figs. 1 Red Lights in the Operating Room We painted our neon tubes with a red colour like in submarines so that we have a good room illumination without disturbing the surgeon (Fig. 4). 2 Inflatable Pillow We use an inflatable pillow which can be formed around the patients head by pumping out the air (Figs. 6). 3 Location of the Patient, Surgeon, Vitrectomy Machine and Scrub Nurse There are many different set-ups of the patient’s bed, vitrectomy machine and surgical table.
The high pressure infusion line is in place. 3 × less flow than 25 G Differences Between 23G, 25G and 27G If the performance of a 23G cutter is 100 %, then a 25G cutter has approximately 30 % less performance and a 27G cutter approximately 30 % less performance (Fig. 5). 4 Double-Cut Vitreous Cutter 7 Performance comparison 23G 25G 27G 100 % 70 % 30 % –30 % –30 % Fig. 5 Performance comparison of a regular and TDC cutter in relation to the gauge. Measured is the aspiration time of artificial vitreous (Courtesy DORC) The disadvantages of a smaller lumen have been overcome through the introduction of powerful vitrectomy machines and novel vitreous cutters which make 27G vitrectomy almost as fast as 25G vitrectomy.