Introduction. Learning cataract surgery is hard enough when you are right handed like your mentor. However when you are left handed and your teacher is right handed it can be tough. Everything seems backwards for both teacher and student. Here I will outline some tips on how to learn and teach cataract surgery when the lefty student meets the righty teacher. I think there are 4 main issues:
Incision Location. Often surgeons will cheat a little bit superior or inferior of temporal toward their dominant hand. However this can be a big issue when the dominant hands of teacher and student don't match. If the lefty student makes the incision at about 4 oclock for a left eye it may be convenient for the student but will be very hard for the right handed teacher if he/she needs to take over the case. There are a couple of solutions to this issue. One is to make the incision exactly temporal at 3 (left eye) or 9 (right eye) oclock so that it is equal for student and teacher. Another solution is to make all of the incisions superior temporal. For the right eye the left handed learner operates superior temporal convenient for his/her left hand. Then the teacher if he/she needs to take over can sit at the head (superior) and the incision will be convenient for the teachers right hand. For the left eye the learner can sit at the head (superior) and make the incison superior temporal with his/her left hand. The teacher on these left eyes can take over by sitting on the side (temporal) and the incision will be in a good location for their right dominant hand. So if the learner sits temporal on right eyes and superior for left eyes taking over the case by a righty will not be an issue.
Some instruments are handed. Yes this is an issue!. While scissors and clamps can be harder for lefties the big issue in ophthalmology is that some of the choppers are made for either right or left handed surgeons. Very confusing as a right handed chopper is held in the righy's left hand. Getting a chopper for a left handed surgeon (to hold in his right hand) can be a problem as the student often has no control over the OR. Play the fairness card. lefty bigots! However dont wait too long as it will take time to get equipment orders approved and in the OR at most large institutions. So i suggest that lefties plan ahead. One of our residents developed some interesting strategies to use right handed choppers despite being a lefty for example see what we called the side saddle chop.
Mirror Image. Just like it is convenient for right handed surgeons to rotate the lens or tear the rhexis in a certain direction the same is true for lefties. But in the other direction. This obvious point took me a while to figure out as a teacher. I like to take the rhexis around clockwise (i am a righty) and it did not occur to me until i had mentored several lefties that they may prefer the mirror of what i was doing and go in the other direction. The same is true for the direction of spinning the lens especially when chopping.
The IOL is made for the right hander. The IOL haptic insertion into the optic is optimized for right handed surgeons. The IOL is designed so that it is very easy to insert when a right handed surgeon pushes the haptic/optic junction with a hook from the right side (with the right hand). As such lefties have to recognize this issue and simply use their non dominant hand right hand for this step. The good news is that while the IOL is optimized for right handed surgeon insertion; the IOL is easier for lefties to remove for the same reason (unfortunately this almost never comes up).
Summary. Lefties should consider sittikng temporal on right eyes and sit superior on left eyes so the right handed attending can easily take over. get a few left handed choppers. Lefties should go clockwise for the rhexis and spin the lens counter clockwise while you chop. Finally, lefties will have to use their right hand to hold the Kuglen or other hook to insert the IOL.
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