Detailing your surgical preferences and planning ahead will go a long way.

Microsurgery is one of most stressful aspects of a starting ophthalmologist’s career. For many, this marks the first time solo in the OR without the guidance and support of an attending. However, there are less commonly discussed variables that augment the anxiety of the first few years of ophthalmic surgery (as if we need any more stressors!).

In this article, I will discuss those variables and provide practical solutions you can use in the OR.

DOCUMENT YOUR SURGICAL PREFERENCES

For most new graduates, the next stop in their career comes with many adjustments. Typically, the entire OR environment is totally different from residency or fellowship — from machines to instruments to staff. One common mistake among trainees is not detailing surgical preferences to the level necessary to complete an order from a supplier. Ideally, you should document everything you have grown comfortable with — exact chopper type, suture material and size for various cases, specific needles used on sutures, favorite membrane peeling forceps, etc. Consider instruments you have used even in uncommon situations, such as an eyelid laceration in the emergency room (remembering ‘6-0 something’ has not been too helpful for me in the past). When nearing time for a new job, cross reference your list of favorites against what the OR stocks. I recommend having a conversation with the surgical director about ordering the remaining necessities as far in advance as possible, as initiating a business relationship with a new company can sometimes take several months in certain settings. Additionally, save your preferred machine settings for cataract surgery or vitrectomy so that you do not need to adjust to a colleague’s profile on the fly.

As a resident and fellow, you probably did not consider the cost of surgery, but some hospitals and ASCs do. So, keep in mind that you may have to make sacrifices or compromises on these preferences when you approach certain cases. Ponder which preferences are most important to you and even contemplate adding them to your contractual demands of your first employer.

For other facets, maintaining some open mindedness and flexibility eases the transition. If only a specific instrument is available, try to discuss the reasoning with one of your future colleagues. Sometimes an experienced surgeon has a sensible explanation for utilizing certain equipment. You may end up deciding to try a new approach.

HAVE A BACKUP PLAN

As a trainee, you can focus on what should happen with each case, while your wise mentors have any backup plans already in their mind for when the operation does not go as planned.

Your task now is more complicated as you must plan for any unexpected pitfalls and which equipment might be needed for changing surgical course. That may involve phoning a more experienced friend or colleague preoperatively. Multiple friends have even called me intraoperatively as they encounter a difficult situation; there is no shame in doing everything you can to ensure a safe outcome for your patient.

In certain settings, having an experienced partner available for challenging surgeries may be feasible. My second surgery as an attending was a complex tractional-rhegmatogenous retinal detachment in a young diabetic patient with hand motion vision. I asked my senior partner if I could operate at the end of his block time so that he could be available to assist if needed, and he was happy to do so.

Additionally, discussing with your OR team to have the anterior vitrector, extra viscoelastic, trypan blue or perfluorocarbon available if needed will reduce the stress in the moment if a change of plan occurs. Be extra nice to your OR team, as they can help smooth your transition (a nice bottle of wine during the holidays can go a long way).

CONCLUSION

Many consider the first 3 to 5 years of ophthalmology practice the most stressful. During this time, your surgical skills will progress from fledgling to jedi master. Growing comfortable with the logistics of a new OR environment will allow this transition to happen more rapidly. OM

Michael Andreoli, MD, specializes in vitreoretinal surgery at Northwestern Medicine in Naperville, Ill., and is the co-founder of TeamedUp.