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.