Solo surgeon strabismus surgery technique

Background Strabismus surgery is frequently undertaken solo without surgical assistants, requiring alternative methods for accurate muscle isolation and placement. We aim to describe a novel single surgeon technique during recti muscle surgery in the management of horizontal strabismus. Methods After isolating the recti muscle on a hook, the muscle is secured with a double armed 6‐0 Vicryl (Ethicon) on a spatulated needle at the point of insertion. A partial thickness bite is taken at the muscle belly followed by two full thickness locking bites at the superior and inferior poles of the muscle. For recessions, the 6‐0 suture is placed behind the blades of the Cook speculum which acts to keep sutures away from the area and provides some traction opposite to that from the Moody forceps. This allows good visualisation and allows the surgeon to mark the suture placement site. Tucking the suture behind the Cook speculum also helps with resection but there is less of a traction element required here. Results This technique has been proven to be effective in allowing the surgeon to operate without an assistant. There have been fewer lists cancellations due to absences and lack of an assistant. Furthermore postoperative results have been comparable to those operated with an assistant. Conclusion The advantages of this technique are its ease of execution without having to rely on extra instrumentation. It allows the solo surgeon to operate without having to depend on an assistant thereby increasing efficiency and reducing waiting list times. It is also a very handy tip and easily taught to trainees. Reference Winter TW, Olson RJ et al. Resident and Fellow Participation in Strabismus Surgery: Effect of level of training and number of assistants on operative time and cost. (2014) Ophthalmology, 121(3), 797‐801.