Office-Based Gynecologic Surgery (OBGS): Past, Present, and Future: Part II.

Office-based gynecologic surgery (OBGS) has become an integral part of modern practice. The technological achievements of the past few decades have dramatically improved our ability to diagnose and treat a variety of common issues that affect fertility and menstruation. Procedures that once required the complex milieu of a hospital or outpatient setting-diagnostic hysteroscopy, endometrial ablation, hysteroscopic polypectomy, and myomectomy-are now well within the reach of motivated and well-trained practitioners. The recent changes in physician reimbursement and the ongoing need to contain healthcare spending have motivated many gynecologists to offer an array of office-based procedures. But, the transition from a hospital-based technique to one that can safely and comfortably be performed in an office requires thoughtful planning in the acquisition of equipment, the training of physicians, nurses, and support staff, and the management of pain. Finally, some form of accreditation should be considered not only to comply with state and local healthcare laws but as a means to offer public reassurance that the care provided in an office meets a well-recognized standard. In this second of a two-part series, we will review the current state of OBGS technology and offer training guidelines to facilitate the transition from the outpatient to the office setting. Additionally, we will discuss pain management for OBGS and the role of accreditation. The lead author will review his 40-year journey in performing both simple and complex gynecologic procedures in an office-based surgery (OBS) setting and offer recommendations for achieving proficiency, safety, and comfort in the office environment. Finally, the authors will offer their thoughts on what can be expected in the future of gynecologic office-based surgery.