_{Published: 26/05/2025, Reading time: 3 minutes}  

In the continuation of their candid and instructive video series, Prof. Kai Januschowski and Dr. Lukas Bisorca-Gassendorf take us even deeper into the world of phaco surgery. Part 2 continues the learning journey by exploring complete procedures, handling complications, and understanding the full potential of your cataract machine and surgical setup. For surgeons on the phaco learning curve, this is pure gold.

Live Phaco Case: Piecing It All Together

After walking us through the individual steps in Part 1, the series now shows what it means to perform a full cataract surgery. In the live example, Prof. Januschowski emphasizes the importance of not skipping fundamentals:

"If you mess up the basic steps and try to take shortcuts, it will come back to haunt you."

The case highlights a temporal approach with a limbal tunnel, careful hydrodissection, and a direct chop technique. Though experienced, Prof. Januschowski still admits:

"I'm losing center there. That's not very good... You can see it happens to everyone."

The lesson: even seasoned surgeons face minor mistakes—what matters is staying calm and correcting them methodically.

The Critical First Quadrant

The removal of the first nuclear quadrant often determines the ease of the rest of the surgery. Dr. Bisorca-Gassendorf points out:

"As soon as you get the first quadrant out, everything goes smooth—unless you get into complications."

This phase places full trust in machine settings. Prof. Januschowski explains the switch to a the SPEEP pump which combines the advantages of Venturi and peristaltic pumps:

"It gives you the aggressiveness of Venturi and the safety of a roller pump."

His advice? Standardize your setup and settings so that efficiency becomes reproducible.

Ruptures: The Elephant in the Room

No surgical training is complete without addressing posterior capsule ruptures. Prof. Januschowski puts it plainly:

"Let’s address the elephant in the room. Ruptures. It will happen to you. And it's painful."

Their advice is both technical and psychological. Dr. Bisorca-Gassendorf recalls:

"You probably will need to go through this... Just stay in the eye, take a breath, analyze the situation."

Even if your instructor takes over early in your training, observing and mentally rehearsing these moments is crucial. A key mantra:

"Don’t rush. Don’t pull out. Stay calm and stabilize."

Machine Settings: Your Hidden Weapon

With guest expert David Oberbichler from Oertli, the team explores how individual settings can make or break your performance. There’s no one-size-fits-all:

"Every surgeon works differently. You need to find your sweet spot."

Higher vacuum and flow rates can actually help achieve faster occlusion. The takeaway? Work closely with your application specialist to find your matching machine settings.

"Just call your tech and say: 'Pimp my settings.'"

Pump Systems Explained

A clear understanding of Venturi vs. peristaltic pumps—and the hybrid SPEEP pump —is essential for modern phaco. Venturi offers immediate vacuum but less control, while peristaltic allows deliberate engagement through occlusion.

"Start with a peristaltic pump and low flow. Then increase as you get more confident."

Understanding how your foot pedal interacts with the system is also crucial. Prof. Januschowski humorously admits:

"I have terrible feet. I either step through or not at all. So, I need help from the machine settings."

It’s a reminder that technical self-awareness is part of surgical mastery.

Final Thoughts: From Mechanics to Mastery

Part 2 of the series shifts the focus from basic steps to the bigger picture: consistency, control, and confidence. Whether it’s managing a rupture, dialing in your machine, or performing a complete surgery, the message is clear:

"Surgery keeps you humble all the time."

There is no end to the learning curve in phaco—but that’s exactly what makes it so rewarding.

Stay tuned for more blog articles!