‘Frag Bag’ helps remove nuclear material during vitrectomy

Using a retractable basket during vitrectomy surgery may help improve pars plana lensectomy.

Originally designed for cystoscopic removal of kidney stones, the nitinol retractable basket, dubbed the “Frag Bag,” can fit in a standard three-port, 23-gauge vitrectomy setup and safely remove nuclear fragments during surgery, Sharon Fekrat, MD, told Ocular Surgery News.

“The Duke team feels that the Frag Bag promotes surgeon control by stabilizing the retained dislocated nuclear material within the adjustable snare while softening it to facilitate its removal. Removing a dislocated nucleus may have now gotten safer,” Fekrat said.

The technique

Fekrat and colleagues reported in Ophthalmic Surgery, Lasers and Imaging Retina the results of a bimanual technique for microincisional stabilization and removal of retained nuclear material using a 1.5-French NCircle nitinol tipless stone extractor (Cook Medical), known as a Frag Bag by the users. When the basket is retracted, it can fit through a 23-gauge valved cannula.

The 1-cm diameter basket is controlled by an external handpiece and is large enough to accommodate the entire crystalline lens, Fekrat said.

The researchers reported on a single case, an 80-year-old male patient who had posterior capsule rupture with loss of nuclear fragments into the vitreous 3 days earlier. Vitrectomy was performed, and the dislocated crystalline lens material was removed from the vitreous cavity.

“The 1.5-French guidewire of the repurposed NCircle nitinol tipless stone extractor fits into the 23-gauge valved cannula, and the basket can then be extended up to a diameter of 1 cm within the vitreous cavity using the external handpiece,” Fekrat said.

During the case, the basket was inserted into the 23-gauge cannula and extended in the mid-vitreous cavity, and the vitreous cutter was passed through the extended basket. The largest nuclear fragment was engaged and brought up into the basket, and then the basket was retracted to secure the fragment.

Best practices

Fekrat and colleagues Duncan Berry, MD, and Scott Walter, MD, said a moderate vacuum of 300 mm Hg and a low cut rate of 1,000 cuts per minute allowed the vitreous cutter to remove the entire nuclear fragment. Also, tightening the basket resulted in softening and exfoliation of the outermost lens fibril. The basket should not be overtightened, which could lead to further fracture of the nucleus into smaller fragments.

Instead, the researchers suggested “gently tightening the snare to allow removal of the softened lens fibrils with the vitreous cutter, without fracturing the nucleus.”

Use of the Frag Bag can potentially make the vitrectomy procedure safer and more efficient by avoiding the need for a phacofragmatome and reducing the number of times instruments come near the retinal surface.

“I have been discussing the Frag Bag with engineers for many years because I am always thinking outside the box, as we do at Duke and as are others around the world, such as Dr. Mura in Saudi Arabia and Dr. Srinivasan in India, who have also been working on similar solutions to this common surgical scenario,” Fekrat said.

Fekrat and colleagues reported no intraoperative or postoperative complications during the case. – by Robert Linnehan

Disclosure: Fekrat reports no relevant financial disclosures.

Using a retractable basket during vitrectomy surgery may help improve pars plana lensectomy.

Originally designed for cystoscopic removal of kidney stones, the nitinol retractable basket, dubbed the “Frag Bag,” can fit in a standard three-port, 23-gauge vitrectomy setup and safely remove nuclear fragments during surgery, Sharon Fekrat, MD, told Ocular Surgery News.

“The Duke team feels that the Frag Bag promotes surgeon control by stabilizing the retained dislocated nuclear material within the adjustable snare while softening it to facilitate its removal. Removing a dislocated nucleus may have now gotten safer,” Fekrat said.

The technique

Fekrat and colleagues reported in Ophthalmic Surgery, Lasers and Imaging Retina the results of a bimanual technique for microincisional stabilization and removal of retained nuclear material using a 1.5-French NCircle nitinol tipless stone extractor (Cook Medical), known as a Frag Bag by the users. When the basket is retracted, it can fit through a 23-gauge valved cannula.

The 1-cm diameter basket is controlled by an external handpiece and is large enough to accommodate the entire crystalline lens, Fekrat said.

The researchers reported on a single case, an 80-year-old male patient who had posterior capsule rupture with loss of nuclear fragments into the vitreous 3 days earlier. Vitrectomy was performed, and the dislocated crystalline lens material was removed from the vitreous cavity.

“The 1.5-French guidewire of the repurposed NCircle nitinol tipless stone extractor fits into the 23-gauge valved cannula, and the basket can then be extended up to a diameter of 1 cm within the vitreous cavity using the external handpiece,” Fekrat said.

During the case, the basket was inserted into the 23-gauge cannula and extended in the mid-vitreous cavity, and the vitreous cutter was passed through the extended basket. The largest nuclear fragment was engaged and brought up into the basket, and then the basket was retracted to secure the fragment.

Best practices

Fekrat and colleagues Duncan Berry, MD, and Scott Walter, MD, said a moderate vacuum of 300 mm Hg and a low cut rate of 1,000 cuts per minute allowed the vitreous cutter to remove the entire nuclear fragment. Also, tightening the basket resulted in softening and exfoliation of the outermost lens fibril. The basket should not be overtightened, which could lead to further fracture of the nucleus into smaller fragments.

Instead, the researchers suggested “gently tightening the snare to allow removal of the softened lens fibrils with the vitreous cutter, without fracturing the nucleus.”

Use of the Frag Bag can potentially make the vitrectomy procedure safer and more efficient by avoiding the need for a phacofragmatome and reducing the number of times instruments come near the retinal surface.

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“I have been discussing the Frag Bag with engineers for many years because I am always thinking outside the box, as we do at Duke and as are others around the world, such as Dr. Mura in Saudi Arabia and Dr. Srinivasan in India, who have also been working on similar solutions to this common surgical scenario,” Fekrat said.

Fekrat and colleagues reported no intraoperative or postoperative complications during the case. – by Robert Linnehan

Disclosure: Fekrat reports no relevant financial disclosures.