The role and benefits of the surgical assistant in phacoemulsification cataract surgery

Ian C. Francis FASOPRS, PhD
Gaurav Bhardwaj BMed
Jenny L. Lauschke BSc(Med), MBBS
Ravjit Singh
Ashish Agar FRANZCO, PhD

Prince of Wales Hospital, The University of NSW, Ophthalmic Surgery Centre:
Sydney, Australia

Introduction: Cataract surgical assistants (CSAs) have almost disappeared from 21st century Operating Rooms aside from Public Hospital Teaching environments. This occurrence was originally justified on a purely economic basis, and was not without resistance from both surgeons and patients, emphasizing the perceived benefits of CSAs. It has occurred despite, or possibly because of, modern phacoemulsification cataract surgery (PCS) being the most successful and commonly performed surgical procedure in the world.

Methods: The benefits of a CSA were studied in a prospective, consecutive series of 160 cases of PCS.

Results: There were no instances in which the presence of a CSA compromised the surgical procedure. In fact, the CSA was found to be universally of benefit. The benefits can be classified into three categories; benefits to the patient, to the surgeon, and to the CSA.

Benefits to the patient include improved perioperative efficiency and communication between patient, anaesthetist, surgeon and CSA.

Benefits to the surgeon include the presence of another informed observer who is knowledgeable about ocular anatomy and surgical technique. Hence the CSA may be able to identify potential complications early, and may possibly be able to assist in their management.

The CSA benefits by undergoing Ophthalmic surgical training including operating microscope use and surgical dexterity. This may possibly enhance his or her progression towards a future career in Ophthalmology.

Conclusion: The overwhelming conclusion of this study was that a CSA is of benefit to all parties involved in modern PCS. Nevertheless, the cost-effectiveness of a CSA has not hitherto been evaluated.