With an operative field that is tiny, ophthalmic surgery seems like a solo-surgeon effort. After all, how many hands can operate on 1 eye at the same time? Perhaps an assistant is helpful for some ocular surgical procedures, but for the most part, we have just the surgeon’s hands operating on the eye. But ophthalmic surgery, similar to just about any surgical procedure, requires important teamwork. Think of it as more of an orchestra or band instead of a soloist. While the surgeon is the most crucial member of the team, always remember that eye surgery is teamwork.
For every cataract surgery, which can be beautifully performed in less than 10 minutes, there are hours of work by many people to make that event happen. Team members often include the surgeon, the scrub tech, the anesthesiologist, the circulating nurse, the ophthalmic tech in the clinic, the preoperative nurse, the postoperative nurse, the surgical coordinator, the surgery scheduler, the ophthalmic technicians in the clinic, and even more members of the team such as receptionists and transcribers.
A great surgery requires the entire team to be functioning and working together and for each person’s role to be defined and respected. When the scrub tech I work with, who has helped me with thousands of cases, makes a suggestion during surgery, I always heed her advice. Her opinion is valuable and she has insight that is not tainted by the hint of denial that we surgeons sometimes have. The answer to, “Doctor, would you like me to increase the phaco power?” is “yes, please!”
The anesthesiologist understands the patient’s systemic health far better than any ophthalmologist, and you should trust their judgment. When the anesthesiologist I work with tells me that it’s better to postpone surgery for a particular patient for medical reasons, I trust his judgment and do exactly that. Cataract surgery is elective, and there is no sense in taking unnecessary risks to do a surgery immediately if it can be done in a safer manner in the near future. Similarly, systemic issues that happen intraoperatively or postoperatively are best handled by the anesthesiologist: someone who regularly uses a stethoscope, unlike an ophthalmologist.
It is also important to heed the advice of the preoperative team members, who may note that the patient has unrealistic expectations. One of the most important rules of elective ophthalmic surgery is to make sure that the results of the procedure exceed the patient’s expectations. The true recipe for happiness with cataract surgery in particular is to underpromise and then overdeliver on the results.
I am sincerely appreciative of all the hard work and effort that each member of the team gives to the patients. Next time you operate, follow my rule: at the end of the surgical day, take time to thank each and every member of your surgical team!