2. Phaco Emulsification
• Surgical cataract removal procedure
• Number 1 therapeutic surgery for
Americans over 65 years of age. 1.4
million procedures performed each
year.
• Becoming very popular among
veterinarians
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3. History of Phacoemulsification
• Definition: Phaco lens shaped, relating to a lens. From
the Greek phakos, lentil (lens), anything shaped like a
lentil
• Invented nearly 40 years ago by Dr. Charles Kelman,
M.D.
• He received a $280,000 grant and 3 year time limit
• Live cats were used as test animals. Early results were
poor and he had blind cats in his basement
• The idea of using ultrasound came to him as he sat in
the dentists chair
4. How does Phaco work?
• Operates on the principle of the
Piezoelectric Effect
• PE discovered by Pierre & Jacques Curie
in the 1880’s
• When crystals are subjected to an
electrical field, they expand and contract in
direct proportion to that electrical field
• Converting electrical energy into
mechanical energy
5. Phaco Procedure
• Handpiece primed and tuned
• Small incision in the eye via diamond knife
• Handpiece tip inserted under cornea
• Phaco machine powers crystals in handpiece
• Handpiece tip vibrates ultrasonically thousands
of times per second to break up (emulsify) the
cataract
• Cataract aspirated and flushed with fluid
solution
• Man-made Intra-Ocular lens inserted
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7. Phaco Machine
• Microprocessor controlled
instrument
• Has capability of irrigation,
aspiration, emulsification, cautery,
and cut modes of operation
• Functions can be controlled by
footpedal, remote control, or on the
console
8. Phaco Handpiece
A slim, lightweight, piezo-electric,
air-cooled, autoclavable
instrument approximately the size
of a magic marker
9. Irrigation
port
Serial # etching Distal tip
Aspiration
port
Cord/strain Stainless steel or Titanium
relief casing/shell
Phaco Handpiece External
Components
2
10. Main Internal Component
• Piezoelectric crystal - each handpiece has a
pair or 2 pairs of ceramic crystals, which vary
in size. They resemble thick washers. When
electrified the tip vibrates longitudinally (like a
jackhammer) thousands of times per second.
Crystals are extremely sensitive to changes in
temperature.
There are no moving parts in the handpiece!
11. Examples of different
handpieces
Alcon 20,000 Legacy AMO Sovereign
Bausch & Lomb Millennium Bausch & Lomb Premiere
13. Alcon Legacy NeoSoniX
• Alcon’s answer for “Cold Phaco”
• Includes a motor that oscillates the tip as
well as performing the typical jackhammer
effect
• Moisture intrusion again biggest source of
failure
15. ALCON INFINITI OZIL
• Alcon’s newest phaco hand piece.
• Has additional internal components.
• Alcon’s most expensive exchange.
16. Alcon Infiniti Ultrasonic
• Functions on the Infiniti phaco system
• Frequency is 40,000 Hz
• An alternative to using the heavy
NeoSoniX or when the doctor does not
want to use the oscillating motion
17. Common Reasons Handpieces
Fail
In general, a handpiece will break
down
after approximately 500 procedures
• Crystals cracked
• Cord (wire) damage
• Connector damage
• Tip damage
• Jammed needles
• Clogged aspiration port
14
18. Common Causes of Handpiece
Failure
• Sterilization is the number one cause of
failure even when performed properly
– Repeated exposure to heat and
pressure causes the crystals to
depolarize, or causes breaks in the
mold/seals which allows moisture
intrusion
– Moisture intrusion will cause electrical
failure
– FOLLOW MANUFACTURER’S
STERILIZATION AND COOLING
INSTRUCTIONS 16
19. Common Causes of Handpiece
Failure
• Rapid Temperature Change
– Not allowed to naturally cool for at least 15
min
– Attempts to expedite cooling can damage
crystals
• Mishandling
– Dropping, pulling rubber boot loose,
misaligning pins, cutting cord, threading
improperly
• Failure to clean
– Failure to clear aspiration port
– Build up of debris on connector 17
20. Repairs
• Only damaged cords, connectors, and shells can
be identified by visual inspection
• For all other problems, the handpiece must be
completely disassembled to evaluate the internal
components to determine cause of failure
• In order to replace any component including the
connector and cord, the entire handpiece must
be taken apart and re-assembled
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21. Handpiece Repair
• Complete disassembly including transducer
assembly from outer shell and transducer
• Replaceable parts are discarded
• Remaining parts ultrasonically
cleaned/inspected
• Transducer reassembled using new parts and
tested
• Transducer assembly mated to new tested
connector and cable assembly – tested again
then placed in shell housing
• Autoclaved and re-tested. 20
22. Tip Repair
• Tip repair only offered on the Alcon 20,000
series models: recessed horn allows
access
• Certain models have “reverse thread”
• Users are prone to over-tightening or
“cross- threading” the reverse threaded
tips
• Area between tip and horn very small and
disassembly is the safest way to
guarantee all particles removed to prevent
going in patient’s eye during a procedure21
23. Ethicon Harmonic Scalpel
repair
• Benjamin Biomedical offers repair of all 3
early generations of Ethicon harmonic
scalpel, plus the new Harmonic Blue.
24. What is a harmonic scalpel?
• Ultrasonic instrument that cuts and
cauterizes at the same time- coagulates
blood proteins-55,000 Hz
• Operates at a much lower temperature
than other instruments- electrical surgical
unit (ESU)
• Produces very little if any smoke or
charring of tissue- clearer surgical field
• Use improves recovery time of patient
25. Who uses the harmonic
scalpel?
• Harmonic scalpel used in all types of open
and laparoscopic procedures
• Very popular for tonsillectomy
• Ob/Gyn
• Can be used in most cases where ESU is
traditionally used
• Becoming more popular for obvious
reasons
26. Scalpels vs. Phaco Handpiece
• Scalpels are very similar to phaco
handpiece in technology
• Also works on the piezoelectric effect
• Plugs into the host system via a cable and
multi-pin connector
27. HARMONIC SCALPELS
• Generation I, obsolete.
• Generation II, diminishing.
• Generation III, most popular.
• Harmonic Blue, newest, growing in
popularity. ( 16 crystals)
28. What’s inside?
• The scalpel has all of the same type
components as the Phaco handpiece
• Piezoelectric crystals (4)
• Connector
• Cable
• Electrodes
• O-rings, seals
29. Repair Procedure
• Repair procedure mimics that of the phacos
• Complete disassembly of scalpel: discard cable,
connector, crystals, electrodes and o-rings
• Inspect and clean salvaged components ultrasonically:
shell, header assembly, horn, etc.
• Complete subassemblies and test each: cable assembly,
transducer stack assembly, cable stack assembly, final
assembly
• Final test, autoclave and re-test
30. Service options
• Manufacturer does not repair. Handpiece or
scalpel are replaced
• Repair or exchange
– Within two working days from approval of repair
• Emergency exchange
– Customer requires handpiece the next day. Send to
customer that night and customer’s broken handpiece
is sent in as an exchange
– No loaners available
22
31. Common Customer
Concerns
• Currently using manufacturer
– Possible reasons- quality, safety, ease,
bad experience with 3rd parties, does not
know alternative exists
– Possible concerns- Price, poor service,
being controlled by manufacturer
We provide better service and price
without sacrificing quality.
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32. Common Customer
Concerns
• Handpiece repair may void machine
warranty
– Ask manufacturer rep to show language
in writing or put this statement in writing
– If has statement in writing ask for a copy
– Do not tell them it is against the law or
try to give legal advice.
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33. Common Customer
Concerns
• Why does the handpiece need a full repair if
only 1 part has gone bad?
– Disassembly needed to get to components
– Same wear on each component
• If only my cord/connector is damaged, why
can’t we just replace it?
– Cannot solder new wire to old connector
• Only the tip is damaged, why do we need full
repair?
– Patient safety, design of handpiece, and repair
procedure
– Manufacturer will not do tip repair 26
34. Points to Remember
• Most of the time a handpiece must be
disassembled to determine which components
have failed. The machine does not provide a
failure analysis on the handpiece. Only external
damage (cord or tip damage) and certain
connector problems can be detected prior to
disassembly.
• Manufacturers do not trouble-shoot or do minor
repairs. They send out exchange handpieces
• Standard warranty – 90 days failure of
component or due to workmanship
35. The Benjamin Biomedical
Difference
• All repairs utilize new components
• Cable, crystals, electrodes, connector
assembly, o-rings and seals
• Custom made cable w/ Aramid fiber
• We use the same vendors for components
as the OEM’s whenever possible
• Unmatched engineering support- lead
engineer for Alcon and AMO on staff
• Annually audited Quality System
36. At Benjamin Biomedical, Quality
Assurance is Key.
• Our quality system is a living, breathing
thing. It does not sit on the shelf until audit
time. We use it every day.
37.
38. Phaco Handpiece
&
Harmonic Scalpel
Design, Care and Repair
Questions and Discussion
