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The Nuc'Cracker

Donald Munro Donald Munro Follow Oct 10, 2021 · 3 mins read
The Nuc'Cracker
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Amsterdam, NL. Sunday 10 October 2021. One of the award-winning videos at this year’s ESCRS congress was,“The Nuc´Cracker SuiteArt applied to Cataract Surgery – Visualizing an Artistic Approach in Education. The video’s authors were : Auerbach FN, Auffarth GU.

This unusual teaching video combines Dr. Florian Auerbach’s artistic talents and his experiences in learning cataract surgery from surgical simulation and hands-on surgery. In this post, Dr Auerbach explains here why he made this 8 minute video and how he made it.

“Teaching cataract surgery is not an easy task. Educational approaches range from reading a book, to watching videos online, over learning step by step from advanced surgeons, to joining wet labs or, last but not least, with the help and support of VR-simulation.”

New approach

“Together with Prof. Auffarth, we decided to take a new approach We wanted to present an artistic and didactic approach to cataract surgery, one where we lay out the important steps of a complete cataract operation, in a step-by-step sequence.

  1. Paracentesis and Clear Corneal Incision (CCI)
  2. Continuous Curvilinear Capsulorhexis (CCC)
  3. Hydrodissection and Hydrodelineation
  4. Phacoemulsification Divide & Conquer (D&C)
  5. Irrigation / Aspiration (I/A)
  6. IOL implantation

For each step, we show first my own hand-drawn medical illustration of the surgical field and the instruments at work; then, secondly, the VR-simulation of the same step; and finally, surgical video footage of this same step.”{: .pic-left}I/A Irrigation and Aspiration

Video born in Lockdown

The background to this new concept of combining artistic portrayal, surgery simulation and real-life surgery came about during the unusual circumstances of the COVID 19 pandemic and lockdown in Germany. “Behind the scenes: it became everyday routine for me to be sitting in front of a computer screen during the Covid-pandemic. I hadn’t the usual access to theatres, opera-houses and museums and I had limited professional time in the operating room, so it came to me to create something new and artistic and something perhaps also beautiful: something to enjoy looking at and yet it combines a kind of playful learning experience: to learn the basic steps in cataract surgery.”


“We named our little opus: “The Nuc´Cracker Suite” because of the cracking-the-nucleus step during the surgical procedure. We further underlined the title by adding the beautiful music of the “Nutcracker” suite from Peter Tchaikovsky. “

A tool for Future education.

Prof. Auffarth summarized, “Important steps during the surgical procedure are sometimes difficult to convey to the novice surgeon. Yet perhaps if we deliver the message using different media to illustrate a technique, then this can be more readily understood. We are fortunate that Dr Auerbach has the artistic skill to illustrating these steps. By mixing illustrations, simulations and video-footage I hope we can highlight certain details in a very specific manner showing the benefits of each technique. Using classical hand-drawn medical illustrations and adding video- and VR-based videos we can elegantly show each single, important step in a cataract operation. The final result shows surgical education can be done in an artistic and attractive way. Perhaps we should lay more emphasis on combining different teaching styles to get the best results in giving surgical tips on each step of the cataract procedure. We thank ESCRS for recognizing this new educational tool, and for giving us this award.”

Dr. med. Univ. Florian N. Auerbach FEBO, MHBA is Augenklinik Oberarzt in the Eye Department of the University Hospital of Heidelberg.

Donald Munro
Written by Donald Munro Follow
Donald J. Munro is the Business Development Director of the Laboratory, University of Heidelberg.