Incorporating DORC EVA NEXUS into a Fellowship Training Regimen? Start Here.

Surgeons who operate with DORC EVA NEXUS operate with one of the world’s most modern vitrectomy platforms. It allows tight control over fluidics, allows surgeons to perform precise vitreous shaving, and permits surgical efficiency. Attendings who teach surgical fellows would be wise to include experience with the DORC EVA NEXUS to expand the surgical armamentarium for trainees. In providing the next class of retina surgeons with multi-platform experience, attendings allow trainees to see which interface, devices, and surgical systems best fit their styles and preferences, unlocking trainees’ potential to for help patients and grow practices.

In 2024, ZEISS expanded its retina portfolio via acquisition of DORC, strengthening both companies’ operational and surgical portfolios. In this partnership, ZEISS and DORC have redefined workflows for vitreoretinal surgeons, streamlined delivery systems, and united a talented workforce — all in service of offering world-class service and technology to retina surgeons and their patients.

Including a new surgical platform into a curriculum can be daunting. If you’re incorporating the DORC EVA NEXUS in your surgical fellowship training, I advise starting with a few basics.
 

Understanding Customizability. Surgeons in the same surgical center have the luxury of saving specifications under their personal profile on the DORC EVA NEXUS. When training fellows, offer them the opportunity to operate with your customized settings so that they can “try on” another surgeon’s style. If they’re lucky enough to train at a practice where multiple surgeons use the DORC EVA NEXUS, they can gain experience with each attending’s preferred settings to widen their experience.

Orientation with the Foot Pedal. On the DORC EVA NEXUS, a wireless dual linear footswitch allows surgeons to control the vitrector and laser in one foot pedal. Fellows who began their training on other surgical platforms are likely used to relying on trained technicians to switch between vitrectomy modes or to change laser settings. I have found that when fellows begin to operate with the DORC EVA NEXUS, they require less assistance from staff and may begin to feel like the surgical platform is an extension of their hands and mind. This learning curve is easy to overcome — and the simplicity of it may be surprising, particularly if a trainee’s surgical volume was higher on another platform.

Understanding Vacuum- vs Flow-Controlled Aspiration for Precision Surgery. Aspiration on the DORC EVA NEXUS can be controlled via a unique fluidic system that controls either fluid flow or vacuum, selectable by the surgeon. The upshot: the ability to reduce a cutter’s sphere of influence, allowing for safe shaving of the vitreous access adjacent to mobile retina. On the other hand, the high vacuum dual-cycle cutter allows for a very high duty cycle enabling efficient core vitrectomy even with small-gauge instrumentation. Fellows training on the DORC EVA NEXUS must get used to the relationship between aspiration and flow, and attendings should demonstrate how different fluidic modes lead to better efficiency and control.

Learning Laser Control. Just as each attending has their own preferred vitrectomy settings, so too does each attending have a unique approach to laser. Those who prefer probes to be further from the retina require different power and duration than those who keep the probe close to the retinal surface. Others attendings favor the use of continuous laser. Laser power and modes can be adjusted on-the-fly via surgeon foot pedal control. Various surgical presentations require different laser treatment patterns, and fellows should orient themselves with these myriad situations and surgeon preferences. They must also learn how to grip, direct, and manipulate a laser probe to safely and efficiently treat all parts of the retina. Learning laser control is key to growing comfortable with any surgical platform, and the DORC EVA NEXUS is no exception.

Vitreoretinal fellows at Wills Eye Hospital experience high surgical volumes, which means they get plenty of time to tweak their surgical approaches in service of becoming better surgeons. Foundational to the surgical fellowship program is exposure to various surgical platforms (and surgeon-specific settings within those platforms). If we think of each platform and customizable setting as a different shoe, this means that fellows are asked to try on hundreds of shoes and decide which one best fits for a given scenario.

As you grow the robustness of your surgical training regimen, consider how exposure to the DORC EVA NEXUS can optimize your fellows’ surgical experience. If you elect to include ZEISS and DORC technology into your curriculum, be sure your fellows orient themselves to DORC EVA NEXUS’s features, such as those discussed above. This deepens their training and gives them the opportunity to see which shoe fits them most comfortably.

If you’re looking to strengthen the quality of your surgical training program, reach out to the ZEISS team to schedule a demo with DORC EVA NEXUS. Just as fellows try out various technologies until they find the right fit, you may find that the shape and scope of ZEISS retina surgery portfolio matches your program’s needs.

^{The statements of the author reflect only his personal opinions and do not necessarily reflect the opinions of any institution with whom he is affiliated.
The author has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.}