Viewpoint
From the Chief Medical Editor

From Russia, With Love

Larry E. Patterson, MD

I recently returned from Moscow. I had been invited to speak at the Fyodorov Eye Microsurgery Institution by my friend Boris Malyugin, known to cataract surgeons as the inventor of the Malyugin Ring. This clinic was made famous by the late Svyatoslav Fyodorov, a pioneer in IOL implantation and developer of the Sputnik lens. Docs my age knew him best as the father of modern radial keratotomy.

However, what I remember most about Dr. Fyodorov was his invention of assembly line surgery. My own patients occasionally joke that my operating day reminds them of an assembly line, watching one patient receive surgery after another. I like to think this comment has usually been made in admiration of my efficiency. But Fyodorov had an actual assembly line, where patients rotated from one doctor to another, each responsible for part of the procedure, while a chief surgeon, occasionally Fyodorov himself, supervised from a video-control room.

Interestingly enough, Fyodorov would have preferred to have been a pilot, but at age 18, he lost a foot in a tragic accident at aviation school. He then enrolled in medical school, choosing ophthalmology in large measure because it was one of the few specialties that allowed him to operate in a seated position. Later in his life he once again pursued flying, ironically losing his life in a helicopter crash at age 72.

No longer using an assembly line, the modern manifestation of Fyodorov's efforts has resulted in a progressive clinic, where up to eight surgeons are capable of simultaneously conducting procedures in a unified operating theater. While perched in a viewing gallery above, I observed five doctors operating.

And then it hit me.

I'm at one of the world's premier clinics, and I'm watching five different surgical teams operating on five different patients — all in the same room! I'll bet a Medicare cutback that they have no higher infection rate than we do. Back in the US, based on no scientific evidence, regulators continually amass numerous bureaucratic regulations regarding sterilization and infection control that adds enormous expense and time to our procedures, yet with no proven benefit.

We are now required to sterilize instruments in a closed container and transport them accordingly, even if the sterilizer room opens directly into the OR. While this practice may be positive in theory, it remains poor in execution. Well-established research proves that the most infections originate from the patient's own flora, or perhaps fauna if it's a particularly bad bug. To reduce infections, do three things: Betadine scrub and eyedrops, isolate the lashes, and secure the wound. Antibiotics may help as well.

It is interesting, at the least, to note that multiple operations have been repeatedly executed in Russia's “community” galleries for many years — with no compromise whatsoever in sterility, results, or recovery.

Oh, I forgot to mention my topic at the conference: Surgical Efficiency — A Western Perspective!