Introduction

Ophthalmology is entering a period of sustained structural pressure driven by demographic change, procedural growth, and workforce constraints. As populations age and life expectancy increases, demand for cataract and vitreoretinal surgery is projected to rise steadily across virtually all regions, placing increasing strain on operating room (OR) capacity and clinical staffing (1).

These pressures could translate into extended surgical wait times, rising backlogs, and increasing productivity expectations per surgeon (2-5). Against this backdrop, efficiency within the operating room emerges as a critical lever to help address capacity limitations. Technologies that reduce procedure time, streamline setup and turnover, and support stable, predictable surgical performance could enable surgeons and surgical teams to treat more patients within existing resource constraints—without compromising clinical outcomes. Rather than replacing the need for workforce growth, such innovations could help bridge the widening gap between rising demand and limited human resources (3-9).

Alcon’s UNITY® VCS/CS platform was developed with these considerations in mind. By integrating advanced fluidics, intelligent intraocular pressure management, customizable illumination, high-speed vitrectomy, and workflow-focused system design into a single, configurable platform, UNITY® VCS/CS expedites and streamlines the console set-up compared to CENTURION® Vision System with Active Sentry and delivers a significantly faster console setup and console teardown time compared to CONSTELLATION® Vision System.

UNITY® VCS/CS is also designed to maintain the surgeon-set IOP throughout all stages of ocular surgery. In addition, the platform includes the first and only multi-spot illuminated laser probe, which dramatically reduces laser application time (11). When combined with Alcon Custom Paks®, UNITY® VCS/CS can further streamline inventory management and support operating room efficiency (10). As a result, the UNITY® VCS/CS System provides enhanced efficiency for both vitreoretinal and cataract surgery (11,12).

An expert panel of four surgeons was brought together from leading European centers to discuss their early clinical, operational, and organizational experience with the recently launched Alcon’s UNITY® VCS/CS platform. The discussion between the four surgeons focused on performance, efficiency, workflow, training, and perceived value for hospitals and patients.

The panel comprised a mix of clinical environments, including university hospitals, public hospitals, and private practices. The panelists were Dr. Cristina Irigoyen (Spain), Professor Aude Couturier (France), Dr. Sébastien Guigou (France) and Dr. Vincenzo Ferrara (Italy).

Panelists reported prior experience with multiple surgical platforms, including CONSTELLATION®, CENTURION®, EVA™, STELLARIS™, and digital visualization systems (e.g., NGENUITY®). Experience with UNITY® VCS/CS ranged from few cases to more than 100 completed cases.

Surgical Efficiency: Enabling Efficiency at Each Surgical Step

A recent study found that The UNITY® VCS System provided a 16% efficiency gain (P<0.05) in overall vitreoretinal OR workflow in a real-world (operating room) setting, a finding that the four panelists described as a commonly noted and practical consideration associated with UNITY® VCS/CS in the context of increasing surgical demand and stable staffing levels.

“Fifteen years ago, I used to do 6 cataracts per session, nowadays I might have to do 10 cataracts per session.” (Dr. Irigoyen)

Surgeons described efficiency gains occurring at multiple stages of the surgical pathway, including console setup, intraoperative workflow, and operating room turnover. For instance, in a real world (operating room) setting, UNITY® TetraSpot laser probe with mixed use of 1, 2 or 4 spot modalities provides significantly faster laser application time (P<0.001).

These gains could be particularly meaningful in high-volume environments, where accumulated time savings could add additional procedures or reduce daily overruns. Also, the UNITY® VCS/CS intuitive system design and guided setup allowed both surgeons and nurses to become operational quickly and with fewer steps compared with prior platforms. This was viewed as especially valuable in hospitals with rotating OR staff or mixed anterior–posterior surgical schedules.

“Much easier for support staff to set up and tear down the machine, reportedly much faster and simpler.” (Dr. Ferrara)

The 2-in-1 platform concept—supporting both cataract and vitreoretinal surgery on a single console—was cited as a major efficiency driver according to the four panelists. They described how eliminating machine changeovers between anterior and posterior cases removed workflow interruptions and reduced idle OR time.

“We both do anterior segment and posterior segment during the same schedule. So, it’s very important for us to use just one machine.” (Dr. Guigou)

Importantly, surgeons stressed that these efficiency gains were not achieved at the expense of safety or control. Instead, they viewed improved efficiency as the result of greater system predictability and stability, allowing surgical teams to work with confidence and consistency throughout the day.

Surgical Performance: Real-time sensing delivers stability and control throughout the procedure

Beyond workflow efficiency, the panel devoted substantial discussion to surgical performance, particularly the role of real-time system responsiveness, fluidics, and intraoperative stability in both anterior and posterior segment surgery.

A central theme was confidence—confidence in maintaining physiologic intraocular pressure, confidence when working close to delicate retinal structures, and confidence when supervising less experienced surgeons.

The four panelists generally observed that UNITY® VCS/CS Intelligent Fluidics and Intelligent IOP control contributed to a precise surgical stability at the surgeon’s desired IOP. This was perceived as especially beneficial during critical steps such as posterior vitreous detachment induction, peripheral vitreous shaving, and procedures involving retinal detachment.

“When working close to the retina or when there is a retinal detachment, UNITY VCS may support surgeon confidence when residents are involved, particularly in relation to traction management and system stability.” (Pr. Couturier)

In cataract surgery, the panelists discussed anterior chamber stability as a consideration, particularly in cases involving patients with higher-risk characteristics, such as glaucoma or optic nerve compromise. They described how predictable chamber behavior was perceived to be helpful in managing more complex cases.

Surgical-performance innovations were also discussed, including real-time monitoring of energy delivery, as UNITY® VCS/CS was able to maintain the desired IOP as set by the surgeon during all ocular surgery steps, and more physiologic IOP has demonstrated lower levels of anterior segment inflammation without compromising efficiency.

Advanced vitreoretinal instrumentation was another focal point. While 25-gauge surgery remains the standard in many centers, with UNITY® 27+ Dynamic Stiffener (DS) system, surgeons described meaningful improvements over previous 27G platforms. UNITY® 27+ DS HyperVit® Dual Blade Vitrectomy Probe is 3 mm longer than CONSTELLATION® Vitrectomy Probes.

“I used the 27G and observed characteristics related to its rigidity and performance.” (Dr. Guigou)

Although panelists believe that adoption of any relevant innovation always take time, they felt that UNITY VCS meaningfully lowered the barriers to its use, particularly in selected cases such as myopic eyes or peripheral work.

Comprehensive Experience: Workflow Integration, Training, and Strategic Value

The third major theme to emerge from the panel discussion was the comprehensive experience of using UNITY® VCS/CS — to encompass training, logistics, digital integration, and institutional strategy.

Among panelists who practice in teaching hospitals, the use of a single, versatile platform for both anterior and posterior procedures that allows automatic switch from flow to vacuum control modes was discussed as a potential advantage. This was seen as simplifying resident training, reducing cognitive load, and allowing trainees to focus on surgical fundamentals rather than machine-specific differences.

“I used UNITY® VCS/CS and felt it offered features that could help support resident participation in more cases and procedural steps.” (Pr. Couturier)

The integration of UNITY® VCS/CS with digital visualization systems such as NGENUITY® was described as having potential relevance for educational settings. Panelists emphasized the value of real-time data visibility—flow, vacuum, and IOP parameters—allowing residents to better understand cause-and-effect relationships during surgery.

“I foresee UNITY® VCS/CS plus NGENUITY® becoming the standard for training new residents and any developing surgeon.” (Dr. Ferrara)

From an operational perspective, the panelists appreciated the impact of streamlined inventory management, particularly the ability to use common consumables and Custom Paks® across configurations. This was perceived to reduce administrative burden, simplify ordering, and support smoother OR preparation.

Finally, panelists discussed the strategic implications of adopting advanced technology. Both academic and private institutions were described as operating in increasingly competitive environments, where access to modern equipment influences surgeon recruitment, trainee selection, and patient perception.

“Residents choose the hospital where they will get their better training, so [acquiring state-of-the-art equipment] it is good for attracting talent.” (Dr. Irigoyen)

Panelists described UNITY® VCS/CS as not only a surgical platform, but a long-term institutional investment for potential efficiency, safety, education, and reputation simultaneously.

Conclusion

The expert panel discussion suggested a high level of alignment among the four surgeons regarding the perceived early benefits of UNITY® VCS/CS in areas such as efficiency, workflow, safety, and training across a range of healthcare settings. Panelists consistently described UNITY® VCS/CS not as a system defined by a single feature, but as a platform whose value is perceived to arise from superior efficiency, the combined integration of intelligent fluidics, physiologic IOP management, advanced instrumentation, digital compatibility, and workflow-oriented design.

While long-term data and broader adoption will further define its role, this early experience raises promising considerations about the potential of UNITY® VCS/CS to support higher surgical volumes, safer procedures, improved training environments, and stronger institutional positioning—key priorities in modern ophthalmic care.

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