Phacoemulsification to manual small-incision cataract surgery: transfer of skills study in a simulated environment

Purpose: To investigate if phacoemulsification experience impacts and transfers to the skill acquisition of novices in manual small incision cataract surgery (MSICS) within a simulation environment. Setting: Copenhagen Academy for Medical Education and Simulation, Denmark. Design: Prospective controlled experimental study. Methods: The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher’s exact test, and individual modules using Fisher-Freeman-Halton analysis. Result: The PG performed significantly better in terms of overall performance score (mean ± SD, PG; 21.8 points ± 2.3 versus CG; 18.9 points ± 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. Conclusion: The results suggest a positive inter-procedural transfer of skills between phacoemulsification and MSICS. Pretraining and experience in phacoemulsification demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that phacoemulsification experience provides an advantage before MSICS training in surgical residency programs.