Console-Associated Surgical Workflow Performance in Vitreoretinal Surgery: A Comparative Time-and-Motion Study of UNITY VCS and CONSTELLATION Vision Systems

Abstract

Vitreoretinal operating rooms face increasing challenges, including workforce shortages and growing patient demand from aging populations. This comparative time-and-motion study assessed if the UNITY® Vitreoretinal Cataract System (UNITY VCS) was associated with differences in console-associated workflow performance in vitreoretinal surgery compared with the CONSTELLATION® Vision System. A prospective, observational, time-and-motion study using a sequential pre–post design was conducted at two sites from May 2024 through July 2025. Adult patients undergoing 25-gauge vitreoretinal surgery were enrolled and received surgery with either the CONSTELLATION or UNITY VCS. The primary endpoint was the duration of console-associated vitreoretinal surgical workflow. Microscope recordings and dedicated operating room (OR) cameras were used to capture surgical steps and timecodes. Data were analyzed using independent t tests with multiplicity adjustment, and mixed-effects models accounting for site and surgeon clustering were used to confirm findings. UNITY VCS was associated with a significantly shorter duration of console-associated vitreoretinal surgical workflow compared with CONSTELLATION (27.3 vs. 32.4 min; absolute mean difference, 5.1 min [95% CI 0.5–9.7]; 16% relative difference; p = 0.029). UNITY VCS was also associated with shorter durations in workflow steps, including setup, teardown, and turnover—as well as in laser photocoagulation (all p < 0.001). Findings from mixed-effects models accounting for clustering by site and surgeon were consistent with the primary analysis. This real-world study found that UNITY VCS was associated with improved console-associated vitreoretinal workflow performance compared with CONSTELLATION. The observed differences were concentrated in OR staff activities and device-enabled workflow components rather than surgeon-controlled operative work. These findings may be operationally relevant for high-volume practices seeking to optimize surgical workflows and address growing demand from an aging patient population. Further studies are needed to evaluate the broader operational implications of these workflow improvements.

The authors' abstract, as published at the source. Ophthalmology and Therapy, 2026 · DOI ↗