Knowing that every advancement in trocar systems has the potential to further improve patients’ clinical outcomes, Peter Szurman, MD, PhD, chief physician at the Eye Clinic Sulzbach in Sulzbach, Germany, was eager to try DORC’s Eva Aveta, a new redesigned trocar cannula system that offers easier insertion, improved retention, and superior wound sealing.

“The Eva Aveta is a significantly improved trocar cannula system for transconjunctival trocar-guided vitrectomy,” says Prof. Szurman, who collaborated on developing the original MVR blade and tested the Eva Aveta. “A patent-pending push-fit connection system allows surgeons to connect to the DORC high-flow infusion cannula, providing an easy, one-step connection for infusion. This allows users to change ports easily during surgery when necessary.”

Adds Arnaud Tellier, director of product management at DORC, headquartered in Zuidland, The Netherlands, “The system provides high-flow infusion performance that balances perfectly with 2-dimensional cutting aspiration flow rates, delivering better IOP control.”

MORE INNOVATIVE FEATURES

Jorge Fortun, MD, associate professor of clinical ophthalmology, and medical director of Bascom Palmer Eye Institute at Palm Beach Gardens in Miami, Florida, who also uses the Eva Aveta, touts multiple benefits of the system. “Redesigning the transition between the trocar blade and the cannula allows for smoother trocar insertion, which also translates into better wound architecture and decreased postoperative wound leakage. The seamless one-step insertion of the high-flow infusion cannula maximizes the potential of the Eva’s platform fluidics. The Aveta trocar cannula also provides better trocar retention throughout procedures.”

Compared to DORC’s current range of trocar cannula, Tellier says the Eva Aveta offers high flow rates without the need to remove the valve. “The redesigned cannula is more compact and offers key features such as a laser-etched shaft for better retention in the sclera; the chamfered leading cannula edge is designed for smooth insertion and optimized wound sealing,” he says.

In combination with the MVR blade, the cannula improves wound sealing and reduces the need to suture sclerotomies, Tellier says. In more than 96% of surgeries, surgeons reported superior wound sealing with Aveta.¹

When used with the Eva system, the Aveta allows surgeons to perform microincisional vitrectomy surgery in 23 gauge, 25 gauge, and 27 gauge — which come in color-coded gauge sizes. “This helps to easily identify gauge sizes and makes the cannula more visible on the eye,” Tellier says.

Its compact design (the trocar cannula head is 20% smaller than the previous design) provides increased stability. A wider base plate ensures a stable connection to the sclera while freeing up more working space around the eye, Tellier says. Guiding instruments through the redesigned cannula head has also been improved with a funnel design that allows for intuitive insertion of instrument tips, including soft-tip, through the cannula.

EASE OF USE

Usability, innovation, and performance were the 3 pillars that led to the Eva Aveta’s development. “We considered feedback from nursing staff and surgeons to optimize workflow and ease of use,” Tellier says. “Some examples are the compact blister design with easy access to the inserter or the push-fit infusion line connection, which allows surgeons to easily connect and switch a port when necessary.”

The push-fit connection is a major advantage, Prof. Szurman says, that allows him to easily connect the infusion cannula. “This gives me peace of mind that the connection is stable and secure during surgery,” he says. “Particularly impressive is that the Eva Aveta is more compact than the previous cannula; it also features a larger hub that allows me to easily grasp the trocar cannula during surgery. I can also easily insert and remove instruments without any risk of displacing the trocar.”

Prof. Szurman uses the trocars in every retinal surgery. “They are sharper than previous trocar systems and the greater flow rate through the high-flow infusion noticeably improves the globe’s stability,” he says. “Accidental disconnection of the infusion line is securely excluded, even in complex surgeries with vast manipulation.”

IMPROVING PATIENT OUTCOMES

Although trocar systems are now the gold standard in retinal surgery, Prof. Szurman says clinically relevant disadvantages for the patient still remained. First, IOP fluctuations could occur due to high suction with limited infusion flow, which led to prolonged healing. Secondly, leaky sclerotomies are still the most important reason for postoperative hypotony. “In contrast, the new laser-etched cannula shaft produces noticeably water-tighter sclerotomies,” he says. “I see the difference at the first postoperative day.”

According to Dr. Fortun, being able to use the high-flow infusion cannula allows surgeons to maximize the Eva platform’s unique fluidics, which translates into reduced IOP fluctuations and reduced traction on tissues, allowing surgeons to have precise flow control.

In 85% of the first procedures performed with Aveta, surgeons rated the system’s overall performance as superior to their current trocar-cannula system. More specifically, in 75% of cases, the connection was rated as superior; in 80%, retention was rated as superior; and in 81%, ease of insertion was rated as superior.² RP

REFERENCES

1. Data on file – DORC.
2. Data based on the first 50 surgeries performed with Eva Aveta – data on file – DORC.