16 |
2 How to Train as a VR Surgeon Outside a Formal Fellowship |
|
|
Table 2.2 (continued) |
|
Element |
Comment |
Multiple visits to |
As the fellow starts to perform surgery on his own, the number of his |
multiple surgeons |
questions will not diminish but multiply. It is preferable to spend |
|
several shorter visits at different time points with different surgeons |
|
than returning to the same surgeon over and over again. The most |
|
effective way of developing one’s own way of doing VR surgery |
|
(the ultimate goal) is a synthesis of everything the fellow has seen |
|
and experienced |
Start own operations |
Nothing is as valuable as an expert’s advice that pertains to the |
with a helpful |
particular case, the specific issue, and the emerging problem during |
expert assisting |
the operation done by the fellow. The advice can easily solve a |
|
problem the fellow may otherwise feel as insurmountable or it can |
|
prevent a complication that otherwise may result |
Never undertake a case |
Once the fellow has a few successful cases, especially if no serious |
that is above your |
complications have occurred, there is a tendency to take on cases |
level of training |
that are too complex. This can have horrible consequences for the |
|
patient and for the fellow as well. VR surgery must never be done |
|
by a surgeon who lost his confidence (see Chap. 11) |
Reviewing surgical |
Watching unedited tapes, if done by undivided attention, can provide |
videotapes |
valuable lessons about surgical maneuvers and unbiased |
|
information about what works and what should be avoided or done |
|
differently. Such a review is of utmost value not only to the fellow |
|
but even to the most experienced surgeon (see Sect. 11.3) |
*Most of what is listed here takes place simultaneously, not in a rigid sequence.
2.2A Word of Caution
Those who are outside a formal fellowship program have less supervision and scrutiny over their progress assuring that they always take the next step gradually (see also Sect. 11.1). This laxity may lead to a dangerous chain of events.
•Failures, some resulting in blind eyes, accumulate. To compensate, the fellow may choose to operate on more and more such cases, which lead to more failures, which seems to reinforce the need to do more cases, a vicious cycle.
•A corollary to this rule is a fellow who is forced to take on complex trauma cases, which are way above his level of expertise, because nobody else at the institution is willing to do them (see Sect. 63.12). The fellow will (have to) try operating in these cases not because he wants to but because he is told to.
–With each successful surgical maneuver,10 the fellow’s ego gets a boost, and the motivation to do more and more complex maneuvers grows.11
–Successful completion of surgical maneuvers can subconsciously make the fellow view VR surgery as a sum of surgical maneuvers. This is normal but very dangerous and must be consciously fought, not the least by the fellow himself. VR surgery is much more than the sum of individual surgical maneuvers – it is strategy first, and tissue tactics only second (see Table 3.1).
10Such as peeling an epiretinal membrane.
11All this is also normal.
Part II
VR Surgery: Basic Principles
Introduction
There are many issues that are rarely if at all discussed in textbooks, even though they have great significance for the VR surgeon in training. These issues include, among others: the rationale for preparing an individualized plan for the entire treatment process and for each operation; a number of “everything-you-always- wanted-to-know-about-vitrectomy-but-were-afraid-to-ask” type of questions (such as the importance of tremor or the length of surgery); the thought process involved in designing one’s own surgical philosophy; the criteria for selecting the personnel that form the VR team; the surgeon’s relationship with his nurse; choosing the equipment, instruments, and materials for VR work; the importance and technique of communicating with the patient; the decision-making whether and when to operate and on which eyeball if the condition is bilateral; the order of cases on a day when multiple vitrectomies are scheduled; and the need for the surgeon to conduct periodical self-examinations.