NEW PRODUCT APPLICATIONS

Incorporating the Benefits of Larger Instruments Into Smaller Ones

Vitreq’s small incision 27-gauge surgery instrumentation fills a void

BY KAREN APPOLD, CONTRIBUTING WRITER

Vitreq’s new 27-gauge instrument fulfills an unmet need in the vitreoretinal field. “I was unsatisfied with the rigidity and durability of existing 27-gauge forceps,” says Kevin J. Blinder, MD, professor of clinical ophthalmology and visual sciences, Washington University, and partner, The Retina Institute, both in St. Louis, MO. As a result, Dr. Blinder was motivated to try Vitreq’s (Kingston, NH) new 27-gauge Shah-style forceps. “I initially used them during a 23-gauge case and was impressed with how well they functioned and grasped tissue,” he recalls. “When I performed the next case with a 27-gauge system, I was surprised that Vitreq’s forceps not only fit through the cannula, but they also performed a lot like my 23-gauge internal limiting membrane forceps.”

WHY THEY WORK WELL

The Vitreq 27-gauge forceps, as well as its scissors, have an ergonomic, lightweight hand piece designed for precise balance and control in the surgeon’s hands. A titanium alloy makes the shaft more rigid, allowing for better functionality while maintaining the light weight that handheld instruments require.

What’s more, the inner and outer capillaries of the shaft allow for maximum tolerances and optimal mass of both shafts — making Vitreq’s forceps 25% less flexible than other comparable forceps, reports Scott Hamor, vice president, Vitreq USA, Inc.

In addition, Vitreq has engineered its tip designs to have an average of 30% more pulling power than similar instruments by increasing the tip’s mass and shortening the tip’s working branch. Wider tip platforms allow for more mass to engage tissue. “Surgeons can more easily remove delicate tissue without shredding or having the tip let go of the tissue,” Hamor says.

In an effort to make the shaft less flexible in smaller-gauge instrumentation, many companies shortened the instrument’s shaft length. “This is problematic because shorter instruments are difficult to use with myopic eyes, which have a longer axial length than a nonmyopic eye,” Hamor says. “In addition, shortening the shaft does not address the loss of grasping power due to the lack of mass at the instrument’s tip.”

LESS INVASIVE AND MUCH MORE

Vitreq’s instruments can be used for many different surgical applications, including epiretinal membrane removal, ILM peeling, and tractional diabetic membranectomy.

“Having smaller-gauge instruments that behave like their larger counterparts gives the surgeon more control during tissue removal,” Hamor says. “This ability allows surgeons to more efficiently remove an epiretinal membrane or ILM.”

Smaller-gauge surgery benefits patients by being less invasive; the smaller the wound, the less likely it will leak postoperatively.

Dr. Blinder says the new instrumentation allows him to consider 27-gauge surgery for a broader spectrum of patients. “As more of the vitrectomy units size down to 27-gauge, we will be able to ease the transition for other physicians,” he says.

He also points out that, by using smaller-gauge technology, the need for intraocular scissors has decreased, which reduces the risk of iatrogenic tears and detachments. “The complication rate of our surgeries has drastically declined — improving our surgeries’ overall success rate,” Dr. Blinder adds. “With 27-gauge, it is very unusual to require sutures for wound closure at the end of a case, augmenting patient comfort.”

COUNT ON DURABILITY

Vitreq’s intraocular forceps and scissors are shipped in a hard-shelled, protective sterilization tray which protects the instrument’s delicate tips. “This reduces the risk of damage as they are never exposed, and are always returned intact after cleaning,” Hamor says.

Dr. Blinder says it is essential for his instrument armamentarium to be durable, because he performs the majority of cases in a physician-owned surgery center and doesn’t use disposable instrumentation due to its higher cost. RP