Office-based Procedures Research Articles

Real-World Data Showing Lack of Complications Without Use of Closure Devices in the Office-based Vascular Procedure Center

Closure devices are available in a range of different schemata to close the percutaneous arteriotomy. Although they may contribute to room turnover and increased time to ambulation, they carry the risk of dissection, thrombosis, failure, and expense that may bring a patient back for an avoidable operation, causing undue stress to a patient who elected to avoid the hospital to seek office-based care. In addition, there is hardship of a foreign object in the skin, increasing inflammation and scarring should the groin need to be reaccessed or exposed. In an office-based setting where adequate manual pressure can be held, their use may be obviated and unnecessary. Without real-world examples of protocols and complication rates, many surgeons may be uncomfortable with this transition. Using our Vascular Quality Initiative database, all patients who underwent an office-based endovascular procedure in which groin access was employed (aortic, iliac, or peripheral stenting, balloon angioplasty, atherectomy, and diagnostic angiograms) from 2015 to 2021 were identified. These procedures were elective and mainly for occlusive disease. Preoperative patient characteristics, procedure characteristics, and access-related outcomes were analyzed. Access guidance was uniformly obtained with ultrasound imaging. In our protocol, protamine is administered routinely. Fifteen minutes of pressure is uniformly held on each groin by the surgical technician, over an area marked out by the surgeon. The patient lays flat for 3-4 hours afterward, depending on sheath size. Patients are reached by telephone 1-3 days after their procedure to assess their immediate postprocedure status. Five hundred eighty-three patients met inclusion criteria. These were 61% male, 67% White, and 30% African American, with an average body mass index of 28. Thirty-six percent needed assistance with daily activities. Thirty percent had coronary artery disease, 22% chronic obstructive pulmonary disease, 45% diabetes mellitus, and 45% were smokers. Preoperative medications that included 73% aspirin and 57% clopidogrel. Redo-groin status was in 61% of patients. On average, largest sheath size was 6F, ranging from 4F to 8F. Protamine was administered in >80% of cases. Access site complication requiring additional observation was 0.5% (n = 3) and these were all hematomas. There were no postprocedure bleeds on follow-up. Any sort of postprocedure complication was 0.9%. Complication causing hospital admission was 0.2%, and none were related to access. The use of closure devices incurs the added risk. These data show a 6-year experience in the office-based setting that not using closure devices and instead using manual pressure is safe without significant complication. This should prompt discussion regarding the necessity of using closure devices in office-based endovascular procedures.

Utility of Virtual Reality During Office-based Venous Procedures

Comfort and safety during surgical procedures is an area for innovation and new interventions. Virtual reality (VR) has been effective in reducing anxiety in patients undergoing outpatient hand surgery and wound care. This study aims to evaluate the utility of VR as an intervention to divert patient attention, alleviate pain, and reduce anxiety during office-based venous procedures.

Efficacy of Office-based Angioplasty for TransAtlantic Inter-Society Consensus C and D Lesions

Outpatient lower extremity angioplasties have become more common than inpatient angioplasties and continue to increase. A large portion of this increase is due to office-based procedures. We chose to examine the efficacy with office-based angioplasties.

Infection Rate Comparison during Transition from Hospital to Office WALANT Enabled by Virtual Reality.

Background:We transitioned our hand practice from the operating room (OR) to our office-based procedure room (OPR) to offer wide-awake, local anesthesia, no tourniquet (WALANT). We have established that using wide-awake virtual reality improves patient comfort and anxiety during wide-awake procedures and helps facilitate our patients’ choice of venue. We aimed to assess the effect of this transition on infection rates for procedures performed by a single surgeon in the OR versus the OPR.Methods:A retrospective chart review was performed on a single surgeon’s adult patients who underwent elective and closed traumatic upper limb surgeries. A surgical site infection was defined as superficial or deep, based on clinical examination conducted by the surgeon, and was treated with antibiotics within a 4-week postoperative window.Results:From August 2017 to August 2019, 538 (216 OR and 322 OPR) consecutive cases met inclusion criteria. There were six (2.78%) superficial infections and zero deep space infections in the OR cohort compared with four (1.24%) superficial and zero deep space infections in the OPR cohort with no statistical significance. Two-thirds of cases were converted to WALANT and delivered in the office.Conclusions:This narrative study concurs with the current literature that WALANT in the office setting is as safe as the hospital OR-based procedures for selected elective cases. By transitioning suitable cases from the OR to the OPR, a surgeon’s overall infection rate should not change.

MP02-19 PROSPECTIVE RANDOMIZED CLINICAL TRIAL TO ASSESS THE UTILITY OF URINALYSIS PRIOR TO OFFICE UROLOGY PROCEDURES

You have accessJournal of UrologyCME1 May 2022MP02-19 PROSPECTIVE RANDOMIZED CLINICAL TRIAL TO ASSESS THE UTILITY OF URINALYSIS PRIOR TO OFFICE UROLOGY PROCEDURES Alexa Rose, Aleah Warden, Sara Best, Tudor Borza, Vani Tadakala, E. Jason Abel, Daniel D. Shapiro, David F. Jarrard, and Kyle A. Richards Alexa RoseAlexa Rose More articles by this author , Aleah WardenAleah Warden More articles by this author , Sara BestSara Best More articles by this author , Tudor BorzaTudor Borza More articles by this author , Vani TadakalaVani Tadakala More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , Daniel D. ShapiroDaniel D. Shapiro More articles by this author , David F. JarrardDavid F. Jarrard More articles by this author , and Kyle A. RichardsKyle A. Richards More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) following office based urology procedures is the most common complication but occurs at a relatively infrequent rate. Due to the volume of office cystoscopy, prostate biopsy, and intravesical bladder cancer therapies (IVT) performed globally, UTI following these procedures is a potential source of significant morbidity to patients and cost to the health systems. Screening urinalysis (UA) is frequently performed prior to these office-based procedures to minimize the risk of UTI. Whether screening UA can reduce the risk of UTI following these procedures is unknown. METHODS: We conducted a multicenter (University of Wisconsin and Madison VA), randomized non-inferiority trial involving patients undergoing office cystoscopy, prostate biopsy, or IVT, in which we compared screening UA vs. no screening UA. Patients were blinded to their randomization arm. We excluded patients with UTI within 1 year, chronic catheter use, and those undergoing stent removals. Both groups completed a questionnaire about their Lower Urinary Tract Symptoms (LUTS) on the day of their procedure, 1-week post-procedure, and 1-month post-procedure. Each follow-up visit we assessed for UTI, hospitalizations, or adverse events. The primary end point was UTI within 30 days of office procedure. UTI was defined as a positive urine culture >10,000 cfu/mL accompanied by symptoms. RESULTS: From 10/2018 to 10/2021, 641 patients were randomly assigned to screening UA (318 patients) or no screening UA (323 patients) of which 157 (24.5%) underwent IVT, 427 (66.6%) underwent cystoscopy, and 57 (8.9%) underwent prostate biopsy. For the entire cohort, the median age was 70 (IQR 63-76), 530 were male (82.7%), 509 (79.4%) had Charlson-comorbidity index > 3, and 621 (97.3%) were white. Prior transurethral urologic procedures (office based or operative) were common in the cohort with 601 (93.8%) patients having undergone a median of 13 (IQR 5-25). History of UTI was present in 115 (17.9%) patients. On the day of the procedure, 48 (11.1%) were noted to have bacteriuria. UTI occurred in five (1.6%, 95% CI 0.7-3.7) patients in the screening UA group and four (1.2%, 95% CI 0.5-3.3) patients in the no screening UA group (OR 0.78, 95% CI 0.21-2.95; p=0.72) which met our predefined non-inferiority difference of 1% between arms. CONCLUSIONS: Omission of pre-procedure urinalysis is not inferior to routine screening urinalysis to prevent post-procedure urinary tract infection in patients undergoing office cystoscopy, intravesical bladder cancer treatment, or prostate biopsy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e17 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexa Rose More articles by this author Aleah Warden More articles by this author Sara Best More articles by this author Tudor Borza More articles by this author Vani Tadakala More articles by this author E. Jason Abel More articles by this author Daniel D. Shapiro More articles by this author David F. Jarrard More articles by this author Kyle A. Richards More articles by this author Expand All Advertisement PDF DownloadLoading ...

Office Based Pediatric Urologic Procedures: A Safe and Effective Alternative to Interventions Under Anesthesia

ObjectiveTo report on our experience performing office-based pediatric urologic procedures. We hypothesize that office-based interventions are safe and effective for children, avoiding unnecessary risk and cost associated with general anesthesia. MethodsWe retrospectively identified patients undergoing office-based interventions from 2014 to 2019, including lysis of penile or labial adhesions, division of skin bridges, meatotomy and excision of benign lesion. Success was defined as a completed attempt in the office. Failure includes any unsuccessful office attempts. Complications include 30-day ED visits/readmissions and recurrent skin bridge post division of skin bridge. ResultsWe identified 1326 interventions: 491 lyses of penile adhesions (37%), 320 division of skin bridges (24%), 128 lyses of labial adhesions (10%), 348 meatotomies (26%), and 39 excisions of benign lesions (3%) [Table 1]. There was a >95% success rate reported in every procedure with an overall complication rate of 0.6%. Excision of benign lesion had 100% success rate. ED visits within 30 days are rare (0.2%), and no patients required admission after their procedure [Table 2]. The rate of recurrence was highest following lysis of labial adhesions (13.3%). Of the 54 patients who underwent retreatment, very few required general anesthesia (n = 6). ConclusionOffice-based urologic interventions in children are well tolerated with excellent safety and efficacy. Complications and recurrence are universally low. Ultimately, 99.5% of this cohort was managed under local anesthetics, thereby avoiding the risks of anesthesia use in the pediatric population.

Gender Differences in Ophthalmic Procedural Volume: A Study of Male vs. Female Glaucoma Specialists

To investigate whether differences in procedural volume exist between practicing male and female glaucoma specialists. A cross-sectional analysis. A total of 213 female and 666 male glaucoma specialists who performed ≥ 11 traditional, incisional glaucoma procedures for Medicare beneficiaries between 2014 and2018. The 2014 to 2018 Medicare Provider Utilization and Payment Data database was queried using Current Procedural Terminology and Evaluation and Management codes to identify clinic visits and cataract, glaucoma drainage implant (GDI), trabeculectomy, minimally invasive glaucoma surgery (MIGS), and office-based glaucoma laser procedures. The number of procedures performed per provider was averaged and compared between genders. The univariate ordinary least squares linear regression analysis was used to investigate the effects of gender on procedural volume. The multivariate ordinary least squares linear regression analysis was used to examine the effects of gender, the number of group practice members, and the number of years after medical school graduation on cataract, GDI, trabeculectomy, MIGS, and glaucoma laser procedural volumes. Mean difference in the number of procedures by gender and predictors of procedural volume. In the univariate analysis, men performed an estimated 7.8 more MIGSs (95% confidence interval [CI], 2.7-12.9; P= 0.003), 138.9 more cataract procedures (95% CI, 59.6-218.3; P= 0.0006), and 1.99 more GDI procedures (95% CI, 0.03-3.95; P= 0.046) than women. This relationship remained true for MIGS and cataract procedures in the multivariate analysis after controlling for clinical volume, the number of group practice members, and the number of years after medical school graduation (MIGS, β= 6.1 [95% CI, 0.5-11.8; P= 0.03]; cataract, β= 110.2 [95% CI, 16.9-203.5; P= 0.02]). Glaucoma drainage implant procedures were no longer associated with the gender of the surgeon in the multivariate analysis (β= 2.1, 95% CI,-0.1 to 4.2; P= 0.06). The volumes of trabeculectomy and office-based glaucoma laser procedures did not differ between the genders in both the univariate (glaucoma laser, β= 7.0 [95% CI,-4.4 to 18.5; P= 0.23]; trabeculectomy, β= 2.7 [95% CI,-0.8 to 6.2; P= 0.13]) and multivariate analyses (glaucoma laser, β=-7.3 [95% CI,-18.7 to 4.1; P= 0.21]; trabeculectomy, β=1.7 [95% CI,-5.6 to 2.1; P= 0.38]). Women performed fewer MIGS and cataract procedures than men, even after controlling for clinical volume, the number of years after medical school graduation, and the number of group practice members. After controlling for these factors, there was no difference in the incisional glaucoma or glaucoma laser procedural volume between genders. Further research is needed to understand factors contributing to these differences.

The Effect of Ultrasonic Surgery Tool in the Treatment of Tonsillolithiasis

Objective This study aimed to reveal the effects of the ultrasonic surgical tools in tonsillolith treatment alongside its complaints as an office-based surgical procedure. Material and Method Forty-four patients included in this study who were aware of the white-yellowish lesions on their tonsils concurrently complained of either halitosis and/or the foreign body sensation. Patients were asked to mark their pain scores on the visual analog scale for the pain on the 1st day after the procedure. Halitosis and foreign body sensation were questionnaired before the procedure. The surgical procedure was performed under local anesthesia with the probe of the ultrasonic surgical tool after the tonsilloliths were removed. Tonsils were examined again, also halitosis and foreign body sensation were questionnaired on the postoperative 6th and 12th month period. Results There was a statistically significant improvement in the patients’ halitosis complaint on the postoperative 6th (p=0.001) and 12th (p=0.000) month when compared to first attendance to the clinic. The foreign body sensation in the throat also had a statistically significant decrease in the postoperative 6th (p=0.000) and 12th month (p=0.000). Results showed that there is a statistically significant improvement of tonsilloliths on the postoperative 6th month (p=0.000) and 12th month (p=0.000). Conclusion The use of ultrasonic surgical tools in the treatment of tonsilloliths can be a favorable one-day office procedure. With its short duration of application, the lower pain scores, the day to return a normal diet, and its satisfactory results this procedure can be carried out easily and safely.

Ambulatory Virtual Care During a Pandemic: Patient Safety Considerations.

The COVID-19 pandemic prompted sudden and fundamental changes in health care, including a rapid rise in the utilization of telehealth services in the ambulatory setting. With the unprecedented and significant decline in traditional office-based visits and procedures, novel patient safety risks and challenges emerged. The ambulatory practices at our quaternary care, academic medical center experienced a 200-fold increase in virtual visit volume between February and April 2020. We convened a multidisciplinary working group dedicated to evaluating quality and safety when providing virtual visits during a pandemic. Our primary outcome was patient experience with virtual care delivery, which was assessed by leveraging patient complaint data and patient satisfaction survey data. For our main focus of patient experience and satisfaction, survey data were analyzed from the approximately 76,616 virtual visit encounters that occurred between March 1, 2020, and April 21, 2020. During this period, 5 patient complaints were filed to the Patient Advocacy Department. Overall, patient satisfaction with telehealth remained stable and high at >93% from February to May 2020. As we assessed these data each month, our working group developed risk mitigation strategies in response to the novel challenges presented by the use of telemedicine due to the COVID-19 pandemic while working to maintain patient satisfaction with care. We identified quality and safety issues around patient factors including optimal triage of patients and use of technology. We also evaluated accessibility to virtual platforms and logistics such as coordination of care for diagnostic testing. Finally, a guidance document was created and communicated to our diverse ambulatory practices to support clinicians. Ambulatory virtual care delivery requires a dynamic, flexible model of care through continuous rapid-cycle process improvement to mitigate patient safety risks during a pandemic, incorporating both provider and patient perspectives.

Advances and future directions in the care of patients with facial paralysis

Advances and future directions in the care of patients with facial paralysis

The role of music in outpatient prostate biopsy: A comprehensive literature review.

Prostate biopsy is a standard urological procedure and a valuable tool for identifying prostate cancer. To assess the effect of music on outpatient prostate biopsy, we aimed to conduct a systematic review of literature to understand if music reduced the use of analgesics and anxiolytics. The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The databases searched included MEDLINE, Scopus, CINAHL, Clinicaltrials.gov, EMBASE, Cochrane library, and Google Scholar, from inception of databases to February 2021. The primary outcome measures were the effect of music on pain and anxiety from the procedure. The initial search yielded 212 articles and after going through titles and abstracts, and six studies (570 patients) were included for the final review. It included five randomized-controlled trials and one case-control study. These studies were done in Korea, USA, Taiwan, and Turkey. Patients had a combination of either local anesthetic gel or periprostatic nerve block or intravenous pethidine. The choice of music was varied and most offered a choice of music to patients. Four of the six studies showed significantly reduced pain and anxiety with the use of music, and the willingness for repeat procedures was higher in two studies. This review has demonstrated that listening to music is associated with reduced anxiety and pain during prostate biopsy. It is likely to, therefore, increase procedural satisfaction, and willingness to undergo the procedure again considering repeated biopsy is sometimes needed in these patients. As music is simple, inexpensive, and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Office-Based Procedures in the Management of Hemorrhoidal Disease: Rubber Band Ligation versus Sclerotherapy – Systematic Review and Meta-Analysis

Introduction: The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL. Methods: Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients’ satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran’s Q test and I2. Results: Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12–1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02–1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01–2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32–2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86–1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I–III). Conclusions: RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.

Midface Rejuvenation Using Juvederm Fillers in Male Patients.

In the recent years, there has been a significant rise in the number of men seeking rejuvenating procedures. The development of minimally invasive, non-surgical, office-based procedures without minimal downtime has stimulated a fresh interest among men who may seek cosmetic treatment to increase competitiveness and appear youthful in the workplace. It is important to understanding the differences in facial features in men and women to achieve more natural results and to reduce the risk of feminizing the male's face. The purpose of this study was to present our experience of midface rejuvenation using hyaluronic acid (HA) fillers in men. The authors discuss the anatomical considerations, pathophysiology of aging, gender considerations, and their injection technique for midface rejuvenation in male patients. Midface rejuvenation was successful in male patients using HA dermal fillers while maintaining the masculine features. The treatment was well tolerated and resulted in high level of satisfaction. Use of injectable HA dermal fillers is a safe, effective, and well-tolerated non-surgical treatment modality for midface rejuvenation in men. A thorough knowledge of the midface anatomy, injection techniques, and properties of individual fillers along with an understanding of the considerations in facial features of men can make injectable dermal fillers a rewarding treatment even in male patients.

Clinical Applications of Office-Based Laryngeal Surgery With KTP Laser

The pulsed photoangiolytic 532-nm potassium-titanyl-phosphate (KTP) laser has emerged in recent years as an efficacious treatment modality for vocal fold lesions. It also has broadened the indications for other laryngeal laser surgery. Features of KTP laser that it is a fiber-based delivery system and its energy is selectively absorbed by oxyhemoglobin make it suitable for office-based laryngeal procedures. An office-based KTP laser surgery provides an alternative management option for benign laryngeal diseases and can be performed comfortably under flexible endoscopic guidance which is placed through the nose of a fully awake patient. Office-based laryngeal surgery with a KTP laser can alleviate the need for general anesthesia. However, there are some limitations to apply due to reduced visual precision and the fact that the vocal folds are moving during procedures. Clinicians should carefully weigh the advantages and disadvantages of office-based procedures before a treatment option is selected. Patient selection and standardized laser energy parameters may help in decreasing complications and improving the treatment results.

Office-Based Procedures for BPH.

Benign prostatic hyperplasia (BPH) is a common disease in men. A rapidly rising demand for safe and effective therapy for BPH has generated novel minimally invasive surgical treatments (MISTs). With multiple procedural options in the urology armamentarium for BPH therapy, we describe the current therapies and outcomes for office-based procedures for BPH including quality of life, voiding symptoms, and sexual function. There are three FDA-approved MISTs (Rezūm, Urolift, and iTind) and three emerging MISTs for BPH. Preliminary data suggest improvement in voiding symptoms and quality of life while minimizing unwanted sexual side effects. Long term data is required on the durability and safety of MISTs for BPH. MISTs mark a paradigm shift in BPH management. Sandwiched between conservative medical management and conventional transurethral surgery, these novel technologies promise to combine efficacy approaching that of TURP while sparing the negative side effects. We envision a future where BPH can be diagnosed and treated in an office-based setting with a standard cystoscope in one procedure.

In-office procedural adjuncts for facial nerve disorders

The objective of this article is to describe the utility of in-office procedures for the treatment of facial nerve disorders. There are multiple procedures that may be performed efficiently under local anesthesia and can dramatically improve facial function and symmetry. Facial nerve clinicians should consider office-based procedures as a mainstay for treating all stages of facial paralysis. The objective of this article is to describe the utility of in-office procedures for the treatment of facial nerve disorders. There are multiple procedures that may be performed efficiently under local anesthesia and can dramatically improve facial function and symmetry. Facial nerve clinicians should consider office-based procedures as a mainstay for treating all stages of facial paralysis.

Management of Men With Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia During and After COVID-19

The lower urinary tract (LUT), in particular the prostate, has been theoretically recognized as a target for SARS-CoV-2. Moreover, common pathophysiological mechanisms have been described for BPE/LUTS and COVID-19, including RAS dysregulation, androgen receptors, and MetS-related factors. These factors raise concerns about the possibility of worse urological outcomes due to BPE/LUTS progression in COVID-19 patients. The available results suggest a correlation between SARS-CoV-2 infection, exacerbation or new onset of LUTS, and semen impairment. BPE patients’ care and management have been deeply affected by COVID-19. In the midst of the pandemic, the main urological guidelines suggested postponement of BPH-related deferrable medical examinations and surgery. Telemedicine, therefore, gained attention and interest. Clinical evidence of impaired QoL or complications expedited surgical intervention. An informed consent covering the risk of COVID-19 and a negative molecular PCR within 72 hours of surgery were mandatory. A reduction in procedures under general anaesthesia was recommended. Long waiting lists accrued worldwide during the pandemic, leading to regular review of the BPE waiting lists and patients’ clinical status, encouraging the increase of minimally invasive office-based procedures, even in the post-COVID-19 era, and the improvement of telemedicine. Prospective studies are still needed to assess the course of LUTS/BPE patients after COVID-19.

The impact of WALANT anesthesia and office-based settings on patient satisfaction after carpal tunnel release: A patient reported outcome study

HypothesisWide awake local anesthesia with no tourniquet (WALANT) and office-based procedures are used in hand surgery. There are limited literature data on patient satisfaction when comparing methods of anesthesia and location of surgery. MethodsWe conducted a retrospective single-surgeon study with patient reported satisfaction in three groups. We compared patient impressions of anesthesia type; WALANT vs locoregional anesthesia plus sedation. We also compared satisfaction in three surgery settings; office surgery vs hospital ambulatory minor procedure room vs main operating room. Group 1 office surgery patients had ultrasound guided surgery with WALANT. Group 2 main operating room surgery patients also had ultrasound guided surgery with WALANT. Group 3 main operating room patients had endoscopic surgery with sedation and a tourniquet. Each group had 30 patients with a minimum follow up of 2 months. We measured overall satisfaction, satisfaction with the organization of care, satisfaction with the administration of anesthesia, and satisfaction with the quality of anesthesia. We also collected secondary data on the resolution of the neuropathic symptoms. ResultsProcedures performed in an office-based setting showed higher rates of patient satisfaction when compared to the ambulatory day surgery setting. WALANT anesthesia also showed significantly higher rates of patient satisfaction on a numerical analog scale when compared to sedation based on, irrespective of the surgical setting. All patients had resolution of their neuropathic symptoms regardless of the technique performed. ConclusionWe found that carpal tunnel releases performed in an office-based setting produces superior patient satisfaction. WALANT anesthesia also provides improved patient satisfaction when compared to sedation and monitoring techniques, irrespective of the surgical setting and location. Carpal tunnel release with WALANT in an office-based setting is better for patient comfort and satisfaction, with no evidence of lesser clinical outcomes at a short term follow-up. Level of evidenceIII.

How to Manage Cervical Os Postmenopausal Stenosis by Hysteroscopya Safe, Painless and Efective Aproach Office-Based

Study Objective Present a feasible, safe, painless, office-based procedure to treat by hysteroscopy cases of cervical OS postmenopausal stenosis. Design Systematic approach to all postmenopausal patients in the clinic with cervical stenosis. Setting Office-based hysteroscopy with Bettocchi Set, without premedication. Patients or Participants 8 Postmenopausal Women with endometrial thickness documented by pelvic ultrasound or MRI & cervical stenosis. Interventions Office-based Hysteroscopy, plasty of the cervical internal OS with fine hysteroscopic scissors. Measurements and Main Results Pain sensation or discomfort, false pathway trough the cervical canal, achieve the goal to enter the cavity safely. Conclusion 8 cases with postmenopausal cervical OS stenosis and need to assess the uterine cavity we could easily and painless perform a safe office-based cervical OS plasty with this systematic approach. Present a feasible, safe, painless, office-based procedure to treat by hysteroscopy cases of cervical OS postmenopausal stenosis. Systematic approach to all postmenopausal patients in the clinic with cervical stenosis. Office-based hysteroscopy with Bettocchi Set, without premedication. 8 Postmenopausal Women with endometrial thickness documented by pelvic ultrasound or MRI & cervical stenosis. Office-based Hysteroscopy, plasty of the cervical internal OS with fine hysteroscopic scissors. Pain sensation or discomfort, false pathway trough the cervical canal, achieve the goal to enter the cavity safely. 8 cases with postmenopausal cervical OS stenosis and need to assess the uterine cavity we could easily and painless perform a safe office-based cervical OS plasty with this systematic approach.

Office-based transnasal oesophagoscopy: Evaluating the safety, efficacy and application in head and neck cancer patients.

Transnasal Oesophagoscopy (TNO) is an approach to inspect the upper aerodigestive tract, especially in the head and neck cancer (HNCA) population that present with dysphagia. Twenty-five (25) office-based TNO procedures were performed, with a same-day discharge rate of 96% (24/25) and no reported complications. This case series is the first to compare preoperative and postoperative outcomes (EAT-10) following stricture dilatation using TNO in the UK. Our results show a statistically significant improvement in symptom severity (EAT-10 scores) (n=11, P=0.001). Nearly half (45.5%) of patients undergoing dilatation developed strictures due to post-radiation/post-laryngectomy complications.Biopsy in 4/5 patients was sufficient fordiagnosis/ruling out disease. Of these patients, 5/5 had a previous HNCA. This study identifies the remit for a new 'one-stop' TNO service for suspected cancer referrals, of which a large proportion are patients with a previous HNCA. Surveillance, therapeutics and diagnostics can be achieved in a single visit. Earlier staging or treatment may be achieved due to a fast turnover in clinic.