My love affair with office based surgery began in 1976. That year an article was published in a distinguished medical journal by Dr. A Jefferson Penfield, from Syracuse, New York, who had performed over 1600 laparoscopies and tubal ligations in his small downtown office! Dr. Penfield had long ago recognized that women found the office environment less stressful and that by eliminating the intimidating environment of an operating room reduced the need for general anesthesia! The “Catch 22” goes like this: hospitals can provide general anesthesia. The bad news is that if you’re in a hospital you’re more likely to need it.
I tucked that in the back of my mind and in 1982, while at the Wilson Health Center, I wanted to learn more about Dr. Penfield’s method. Back then, as today, insurance companies were looking for ways to cut costs and so this seemed like something worth exploring. The day I spent with Dr. Penfield was truly a life changing experience. Instead of patients spending 4- 6 hours at a hospital for a tubal ligation or a laparoscopy they were generally in and out of the office in 60 or 90 minutes. The staff worked like a well-oiled machine – because they always worked together. How different from a hospital, where frankly, the staff can vary in a single day over the course of 2 or 3 cases. Patients seemed so much more relaxed in an environment in the relaxed atmosphere of an office.
In 1982 many physicians at local hospitals had not adopted laparoscopic surgery—mostly out of the natural fear of learning a new technique—and here was a gifted surgeon offering this alternative to women in his very own office.
It was clear that there were many advantages.
From the physician’s standpoint it was much easier to schedule cases. Additionally, the “operating room” could be set up according to his or her needs— instead of the particular needs of 30-40 different physicians. The surgeon always knew who his assistants were—they were members of the office staff. And cases were rarely delayed because of the numerous reasons that hospitals rarely run on time.
From a woman’s perspective there are many advantages:
- Appointments are much more flexible. For instance, in our office, we find that many women prefer elective surgery on a Friday so they can use a three day weekend to recover if they need to. For other women, they may have a day off during the week and we can accommodate them as well. The point is that with office based surgery there are just two schedules to coordinate—yours and ours. With hospital based procedures there are 3 schedules that need to be coordinated—trying to get the stars into perfect alignment isn’t often easy.
- You’re going to be in familiar surroundings. You already know what your doctor’s office looks like and who’ll be assisting him or her. There’s none of the anxiety that goes along with trying to negotiate the complexities of a hospital. There’s no “follow the yellow line to the red elevator to the third floor!”
- You don’t have to get to the office 2 hours before your surgery is scheduled to start only to find that when you’re there your surgery has been delayed by an hour!
- You don’t need general anesthesia! One of the really valuable benefits of office-based surgery is that it can be performed under conscious sedation. The major advantage of conscious sedation is that you’ll be able to avoid anesthetic gases and the need for a machine to breathe for you. With conscious sedation you’re in a “twilight” sleep which can be carefully regulated.
- Recovery from office based surgery is much quicker than from hospital- based surgery. For instance the time you spend in our office for a sterilization procedure is between 75 – 90 minutes. The same procedure— which only takes 5-10 minutes to perform—would require you to spend at least 4-5 hours! And that assumes that there are no delays. Remember that your 8 AM procedure at the hospital requires that you get there at 6 AM (2 hours prior), doesn’t actually begin until 8:30 and often requires another 2 hours between extra O.R. and recovery room time.
Now a few disclaimers are in order. Not every operation can be performed in an office. Many complex procedures, such as operative laparoscopies, still require a hospital—at least for now. Office based surgery is not available to women with unstable medical conditions. There are other reasons that women may not be a candidate for office-based surgery and ultimately this is something you’ll have to discuss with us prior to your procedure.
Office-based surgery and cost
In most cases your co-pay for an office based procedure is a small fraction of what it would be in a hospital. This will vary from one insurance policy to the next but we can check your individual policy for specifics.
As of July 14, 2009, many office based procedures can only be performed in an accredited office. Specifically, any procedure that requires more than minimal sedation must be accredited by a New York State approved accreditation agency. The accreditation process is complex, rigorous and demanding. In order to achieve accreditation we spent nearly a year developing protocols, policies and procedures and honing our skills. We are proud to be—as of this writing—the only accredited gynecology office in Western New York! No doubt others will follow in the months ahead. Our staff has worked diligently to bring the highest quality office-based surgical facility available in Western New York.
Other advantages of having your surgery at an accredited facility
From the standpoint of the woman undergoing surgery there are several major reasons for having your surgery performed at an accredited facility.
First, we are able to effectively control pain. Many offices will be offering office- based surgery in the months and years to come. However, they will be limited in the kinds of medications that can be used in order to control the unexpected. The truth is that we’re all different and we all have a different tolerance to pain. You may be told that an office Essure (sterilization) procedure can be done with oral medications or intravenous Toradol (ketorolac). While these procedures can be performed with these medications a significant number of women do not have a good experience with procedures performed without the use of conscious sedation. Think about it. Would you have your colonoscopy performed without the ability of your physician to give you conscious sedation? You might start without it and do fine, but if half-way through the procedure you couldn’t continue because of pain….what’s the next step?