Maximizing Surgical Efficiency With the Stellaris PC

Whether in a hospital OR or in an ambulatory surgery center (ASC), efficiency is critical. More than just increasing procedure speed or number of cases per day, efficiency is about achieving the best possible outcomes for patients while minimizing the time, resources, and effort necessary to achieve those results. For me, it is also about making sure my staff has a positive work experience, leaving each day with a sense of satisfaction and accomplishment. Therefore, in addition to evaluating the use of physical space and human, material, and financial resources, I also consider ergonomic and control features that aid the effectiveness and comfort of my staff and me.

The choice of surgical equipment can affect all of these factors, and it plays a significant role in maximizing surgical efficiency. When our practice began operating in an ASC, we needed a vitrectomy machine that would allow us to do the most complex cases in an efficient and cost-effective manner. It was also desirable that the platform have the capability to perform cataract surgery. Using these criteria, we selected the Stellaris PC Vision Enhancement System (Bausch + Lomb). After 5 years and more than 1000 cases, I have found that the Stellaris PC offers a number of advantages that have considerably enhanced surgical efficiency in my practice.

KEY FEATURES

Combined Surgical Ability

The Stellaris PC is a combined vitrectomy and phacoemulsification system with an integrated 532-nm laser that allows the surgeon to perform anterior, posterior, and combined surgery using a single platform. All of its functionality is controlled by one software program (Activate Plus) with a consistent, user-friendly graphical interface for both anterior and posterior surgery.

The Stellaris PC platform also has a compact design, making it a good choice for our multispecialty ASC; its small footprint makes it easy to move into and out of the OR. Taken together, these features offer efficiencies in cost, the use of space and materials, and the time and effort that would otherwise be spent switching machines or configurations between cases. For combined surgery, eliminating the need for multiple machines and packs also helps minimize cost and complexity.

Footpedal

The Stellaris PC platform features a wireless, dual-linear footpedal (Figure 1) with four fully programmable buttons and integrated laser control, which means fewer pedals and fewer cords than with previous systems, reducing clutter. The dual-linear feature allows the surgeon to independently control two continuous functions simultaneously—for example, fragmentation power and vacuum—in contrast with the typical pedal that allows linear control of only one function (typically vacuum).

I find dual-linear control particularly useful when employing the fragmatome to remove dislocated lens fragments. I engage the lens fragment with gradually increasing vacuum, and, once I am sure I have good purchase, I slowly increase fragmentation power to emulsify the lens material without repelling the fragment.

The footpedal includes an integrated laser firing switch, which is unique to Stellaris PC. This allows me to engage the laser without having to search for another footpedal, as the laser-ready screen is automatically activated upon opening the safety cover. The redesigned pedal with ergonomic foot rest improves surgeon comfort and provides enhanced control, particularly for long procedures. The angle of the pedal has been modified to help keep the foot in a more relaxed, neutral position in the “off” position.

Figure 1. The Stellaris PC Vision Enhancement System and wireless, dual-linear footpedal.

Software

The Stellaris PC platform software interface is straightforward and easy for the OR staff to master. Settings for the programmable footpedal and for each step of the procedure can be customized for each surgeon. These settings can be modified easily during the case and stored in the memory of the Stellaris PC. Furthermore, the Activate Plus software allows the user to save the “end of case” screens to the hard drive or export them to a memory stick.

Light Source 

The Stellaris PC comes with a dual light source and multiple surgeon-selected color filters that allow differentiated viewing. The surgeon can change color filters using the footpedal (Figure 2). Alternatively, a surgical assistant can make the adjustments on screen. In a recent survey, a significant percentage of surgeons reported that certain color filters made it easier to perform particular parts of cases (eg, amber light for fluid-air exchange, green light for membrane peeling).1

ACCESSORIES

Valved Cannulas

The easy-to-insert Entry Site Alignment (ESA) valved cannulas help maintain stable intraocular pressure during surgery, and the tapered trocar blade creates an excellent wound that seals nicely. Microtexturing on the outer surface of the cannulas helps to keep them secure in the wound, but it does not interfere with removal at the end of the case.

The cannula design also facilitates instrument exchange. Beneath the valve is a funnel-shaped opening that helps direct instruments into the central lumen. The valve is removable, which is helpful when using instruments that cannot be introduced easily through a valve or if one desires unrestricted flow through the cannula. The translucent valve material transmits a bit of light, creating a subtle glow that makes for easier instrument exchange in dim lighting.

Chandelier Lighting

The Stellaris PC will soon offer an adjustable chandelier in both 23 and 25 gauges that integrates with the ESA valved cannulas. The chandelier will also provide improved diffuse lighting and efficient light control. It will form-fit into the ESA ports and facilitate bimanual surgery.

Figure 2. Multiple surgeon-selected color filters allow differentiated tissue visualization.

Fragmentation Needle

A 23-gauge fragmentation needle allows surgeons to perform pars plana lensectomy or to remove dislocated lens fragments through 23-gauge wounds. This enables surgeons to perform sutureless lensectomy, which means faster recovery times and happier patients (and referring surgeons).

CONCLUSION

The Stellaris PC is an excellent system for the retina ASC or for any OR seeking a relatively compact but full-featured machine. It incorporates Bausch + Lomb’s phacoemulsification technology, making it a good choice for facilities in which combined vitrectomy and phacoemulsification procedures or routine cataract surgeries are performed.

My experience with the Stellaris PC has been excellent. My staff finds the machine easy to set up and use, and the other surgeons and I at the facility can perform the most complex cases without compromise. It is a platform designed for incremental improvements, and I anticipate that future enhancements to the Stellaris PC will keep it at the forefront of vitreoretinal surgical technology. n

Carl C. Awh, MD, is president of Tennessee Retina, PC, a private group retina practice in Nashville, Tenn. He is a member of the Retina Today Editorial Board and serves as secretary of the American Society of Retina Specialists. He states that he is a consultant to Bausch + Lomb. Dr. Awh may be reached at carlawh@gmail.com.

1. Chow D. Effect of filters on tissue visualization in vitreoretinal surgery. Poster presented at: World Ophthalmology Congress; April 2014; Tokyo, Japan.