By Ulrich Spandau, Mitrofanis Pavlidis
This publication presents step by step directions on tips to function with 27G instrumentation in quite a lot of surgical symptoms, together with vitreous floaters, macular holes, dropped nucleus, retinal detachment, diabetic retinopathy, submacular hemorrhage, retinopathy of prematurity and lots more and plenty trauma. All surgical procedures are approached in cookbook style, with preliminary insurance of the “ingredients” (devices and tools) after which meticulous description of guidance and function with helping images, drawings and video clips. moreover, the diversities and merits compared to 23G and 25G vitrectomy are highlighted.
Small-gauge vitrectomy has extensively replaced the ways that vitrectomy is played. 27G vitrectomy is the latest and most enjoyable improvement in small-gauge vitrectomy. The therapeutic time is quicker however the small diameter prolongs the length of surgical procedure. This problem has been conquer with robust new vitrectomy machines and innovative vitreous cutters with slicing blades making 27G vitrectomy as quick as 25G. This new apparatus has extended the symptoms for 27G surgical procedures immensely from detachment surgical procedure to retinopathy of prematurity and the appearance of recent tools may perhaps make 27G the optimum sooner or later. This ebook, written via authors with large event in 27G vitrectomy, will allow surgeons to completely take advantage of its advantages.
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Extra info for 27-Gauge Vitrectomy: Minimal Sclerotomies for Maximal Results
3 The New TDC Cutter Is Much Faster Than the Regular Cutter 4 6 6 7 7 7 7 Trocar Against No Trocar The most essential development of small-gauge vitrectomy was the introduction of a trocar which rests inside the sclera. Instruments are much easier introduced, the trocar protects the sclera against injury through the instruments and a trocar is easier to find than a usual sclerotomy. The disadvantage of the trocar compared to the usual sclerotomy is the excessive leakage of fluid through the trocars.
The companies with the biggest 27G portfolio are DORC, Synergetics, Alcon and Medilens. The 27G standard instruments (light pipe and vitreous cutter) are softer than their 25G counterparts. They bend more easily when working in the periphery. 5 27G Standard Instruments 27 Fig. 12 The vitrectomy instrument set at the University Hospital in Uppsala Fig. 1 Vitreous Cutter (Figs. 20) High-speed vitreous cutters have a cut rate of 5000–7500 cuts/min. The newest generation of vitreous cutters has a double cut rate of 10,000–15,000 cuts/min (Two Dimensions Cutter, DORC).
In old cutters one movement (forwards and backwards) results in one cut. 0 0 2000 4000 6000 8000 Cut rate [cpm] Fig. 9 Comparison of an old 23G cutter vs a new TDC 27G cutter. The new cutter has a stable flow in the complete cutting range from 0 to 8000 cuts/min. The old cutter has a high aspiration at 1000 cuts/min and a low aspiration at 8000 cuts/min TDC cutter Regular cutter Comparison 23G TDC 23G regular 164 % 25G TDC 25G regular 176 % 27G TDC 27G regular 150 % 27G TDC 23G regular 48 % 27G TDC 25G regular 71 % 27G TDC 27G regular 150 % Fig.