March 2009 Supplement Return to Homepage

Surgical Efficiencies on the CONSTELLATION Vision System

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Webster’s Dictionary defines efficiency as “the safe production of the desired effects or results with minimum waste of time, effort or skill.” Safety is the primary component in the surgical efficiencies that are delivered by the V-LOCITY Efficiency Components on the CONSTELLATION Vision System (Alcon Laboratories, Inc., Fort Worth, TX). This article will review the V-LOCITY Efficiency Components, focusing on how each feature increases the safe delivery of care to our patients.

PREOPERATIVE COMPONENTS
A common concern among vitreoretinal surgeons is the shortage of experienced and educated surgical staff. To that end, the V-LOCITY system incorporates two different avenues for staff education: V-LOCITY Help and Wizard Help. V-LOCITY Help allows for a detailed review of procedures, with step-by-step instruction and surgical videos. Wizard Help goes even further by allowing stop and start setup, which provides similar instruction and videos, but that can be paused so that technicians can perform the actions described and then continue the video instruction as they move along in the process. These features, embedded into the CONSTELLATION system, can be used as either a primary resource or as a refresher.

Additional smart components on the CONSTELLATION system are ENGAUGE Radio Frequency Identification (RFID) and a bar-code scanner which works to simplify setup of the system. The bar-code scanner enables technicians to scan the disposable vitrectomy pak and the system will automatically recognize whether it is 20, 23, or 25 gauge. The ring lighting system indicates whether the probes have been plugged in correctly (initially blue, the light will change to green with proper insertion or amber for improper insertion). Additionally the RFID system will automatically normalize the light output for the technology being used.

The other function of the bar code scanner is to monitor and record the vitrectomy packs or consumables that are being used at any time during a procedure with automatic population of the consumables list window, which is a useful function for inventory control and billing.

Push priming on the CONSTELLATION system allows for fast priming for 20-, 23-, and 25-gauge vitrectomy. The system is automatically calibrated for intraocular pressure (IOP) control and allows one-button priming of all surgical functions. This feature is critical in improving efficiency of OR turnover. As seen in Figure 1, a green bar runs along each station, and if there is a problem at any point, the bar becomes amber and stops the machine, so the scrub tech can locate the problem and correct it immediately.

Another feature of the V-LOCITY Efficiency Components that I find to be important is the articulating arm. The arm is completely maneuverable, flexible, draped for sterility, and can be easily adjusted with one hand.

These preoperative components allow surgery to be set up by one individual, and the surgeon merely sits down and starts operating.

OPERATIVE COMPONENTS
During surgery, there are several components that improve efficiency. The first is the auto-infusion valve (Figure 2). The auto infusion valve allows the surgeon to switch from fluid to air with a simple toggle of the switch on the foot pedal, eliminating the need for a scrub tech or the circulator to be involved. The embedded PUREPOINT laser (Alcon Laboratories, Inc.) with voice recognition and multifunction foot pedal, is also a vast improvement over older systems.

Although I prefer not to use diathermy in my procedures, Alcon has improved on this technology with proportional diathermy, which allows full surgeon control. The surgeon can increase the diathermy to control bleeding. The higher frequency in proportional diathermy translates to a more confined treatment that has a lower amount of penetration.

The reflux options allow for microreflux, which is short duration of pressure that is provided to the suction port to blow away the blood from the top of the retina, and to which most surgeons are accustomed. Proportional reflux, however, is an entirely new innovation that provides power to the suction port that works more like a windshield wiper—it enables the surgeon to gradually and slowly wipe the blood away in a controlled manner, using pressure from 0 mm Hg to 120 mm Hg.

The V-LOCITY autogas fill component (Figure 3) allows the scrub tech to completely fill the syringe with pure intraocular gas, either C3F8 or SF6. This component both improves efficiency and reduces waste of a significantly expensive surgical tool.

POSTOPERATIVE COMPONENTS
At the end of surgery, the V-LOCITY Efficiency Components produces end-case metrics (Figure 4), which summarize the procedure, how much vitrectomy and phaco time was used, the power used, among other factors. An equally powerful postoperative tool is the operative record (Figure 4), which generates a list of all the consumables used during a procedure and that can be transmitted to a wireless printer. In one report, inventory control, billing, and dictation are simplified.

CASE REPORTS
To illustrate how the V-LOCITY Efficiency Components fit into surgery, I will describe one of the first cases that I performed with the CONSTELLATION Vision System. A young, poorly compliant patient with diabetes presented with a combined traction and rhegmatogenous retinal detachment. For this patient, I performed a core vitrectomy with a speed of 4000 cpm, vacuum of 400 mm Hg, and an open-bias duty cycle to allow high flow. When I went close to the retina, I switched to shave mode at 5000 cpm, vacuum of 400 mm Hg, and a closed-bias duty cycle to limit flow.

Upon encountering thick adherent tissue in the detached retina with all the vitreous removed, I was comfortable decreasing my cut rate to 3000 cpm, and keeping vacuum constant with an open-bias duty cycle for increased followability. An open-bias duty cycle is useful not only for fibrous tissue, but also for retained lens material.

I set my IOP control higher, at about 40 mm Hg, and although I did not have to use diathermy for this case, the proportional component was there if I had needed it.

I initiated fluid-air exchange with the pedal, toggling it myself, and then used the PurePoint laser and finished with a gas fill. What is critical about the V-LOCITY Efficiency Components in this case, is that, except for the gas fill, all steps in the procedure can be completed by the surgeon. We have never before had a machine that concentrates solely on the surgeon and with the CONSTELLATION, all that is required for a safe and efficient procedure is the surgeon and a good scrub tech.

WHERE EFFICIENCY MATTERS
Whether you are operating in an ambulatory surgery center setting or a hospital setting, the V-LOCITY Efficiency Components on the CONSTELLATION system increase safety and efficiency, allowing vitreoretinal surgeons more control than has ever been available. This machine has fewer steps to get the job done than ever.

Pravin U. Dugel, MD, is Managing Partner of Retinal Consultants of Arizona and Founding Member of the Spectra Eye Institute in Sun City, AZ. He is a Retina Today Editorial Board Member. Dr. Dugel can be reached via e-mail at pdugel@gmail.com.

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