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Archive April 2020 XXI, No. 4

Office-based Procedures Growing in Popularity

The evolution of surgical care continues as cases move on from the OR.

Adam Taylor

BIO

IN AND OUT 
IN AND OUT  Better topical anesthetics and other advances have made balloon sinuplasty a popular procedure for doctors' offices, as the surgery allows patients to forgo general anesthesia, recover quickly and even drive themselves home.
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Technological advancements have allowed for the gradual shift of complex surgeries from acute care hospitals to outpatient ORs. Several procedures are on the move again, this time to office-based procedure rooms, thanks to minimally invasive approaches, improved pain control options and progressive surgeons who want to provide patients with convenient, effective care.

1. Balloon sinuplasty

This minimally invasive procedure can be safely performed as an office-based procedure, according to Mani Zadeh, MD, FACS, a Los Angeles-based ENT surgeon. Dr. Zadeh estimates that at least half of the balloon sinuplasties performed nationally now take place in doctors' offices. "It's a procedure for which general anesthesia is not required," says Dr. Zadeh. "We can use local or topical anesthetics that greatly minimize any discomfort."

The procedure treats sinusitis by widening the sinus drainage cavity to six millimeters. A deflated or compressed balloon is inserted into the narrow portion of the patient's sinus. When inflated, it essentially squeezes and crushes the soft tissue and creates microfractures in the nearby bone to widen the cavity.

Performing the procedure in the office has multiple benefits for patients. First, they don't have to undergo general anesthesia. Because of that, the recovery is quick. They're awake for the entirely of the operation — the worst post-op symptom is often the feeling of having a stuffy nose — so they can drive themselves home. Patients also avoid the time-consuming admissions process at a hospital or surgery center, and they can skip the pre-op blood test that's part of the evaluation to determine if they're a safe candidate for general anesthesia.

The local anesthetics used for balloon sinuplasties have improved in the last two years, after the operation had begun to move to procedure room, which makes it even more suitable for the office setting. Dr. Zadeh says he used to use common topical sprays or local injectable anesthetics. Now, he partners with compounding pharmacies to increase the concentration of tetracaine, which is commonly used at a lower strength in eye procedures, to 6% in the local anesthetic he uses, making it effective in sinus surgeries. Further, the higher-dose tetracaine used to come in a liquid that tended to drip to the back of the throat. Now it's delivered in a paste form that makes its coverage more precise and effective. "These two simple improvements have made a tremendous difference," says Dr. Zadeh.

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