Impact of the learning curve on intraoperative surgical time in femtosecond laser-assisted cataract surgery

PURPOSE: To analyze the impact of learning curve on operating room (OR) times, femtosecond laser times, procedure time (time for laser and non-laser steps combined), and surgical time (procedure time minus transfer and preoperative times) during transition to femtosecond laser-assisted cataract surgery (FLACS) and comparison with conventional phacoemulsification. METHODS: In this retrospective, comparative case series, patients undergoing FLACS by an experienced surgeon between November 2012 and June 2014 were reviewed using the Catalys Precision Laser system (Abbott Medical Optics, Santa Ana, CA). The cohort was divided into five sequential groups of roughly equally sized cohorts (n = 33 for groups 1 to 4, n = 34 for group 5) and temporal change in surgical times was compared. For controls, 50 consecutive patients who underwent phacoemulsification concurrently were reviewed. RESULTS: There were 166 eyes evaluated that underwent FLACS. Femtosecond laser time shortened through the first three groups (group 1: 4.37 minutes vs group 3: 3.37 minutes, P < .05) but plateaued thereafter (group 4: 3:43 minutes, group 5: 3:35 minutes, P > .05). Total FLACS OR time reduced through sequential groups (group 1: 44 minutes vs group 5: 34 minutes, P < .001). Procedure time reduced from 33 (group 1) to 23 (group 5) minutes (P < .001). However, surgical and total OR time for group 5 (0:17 ± 0.02 and 0:34 ± 0:04 minutes, respectively) remained longer than phacoemulsification (0.14 ± 0:04 and 0:29 ± 0:05 minutes, respectively, both P < .05). CONCLUSIONS: Despite significant reduction in OR times with increasing surgeon experience, FLACS required longer overall procedure times and surgical times compared to phacoemulsification, even when approaching 200 cases. Surgeons and institutions should budget for increased surgical times and associated costs when transitioning to FLACS.