Why Choose Office Based Hand Surgery?Wide Awake Cover Lalonde

Office based hand surgery, also called WALANT, is hand surgery that can be performed safely and effectively in an office surgery suite. WALANT is an acronym for a new surgical technique that has been rapidly adopted throughout the world, and is now gaining traction in major cities and universities in the United States. WALANT stands for Wide Awake Local Anesthetic No Tourniquet technique for surgery.This technique predominantly refers to procedures of the hand and upper extremity, but can also apply to many face and soft tissue procedures.  It simply means that surgery can be done safely in an office setting using only local anesthesia. It was popularized by Plastic Surgeons in Canada who were resource strapped as they could not get enough operating room time at their hospitals. They gradually transitioned to doing more procedures in office surgery suites. With time these surgeons found that this was actually a superior technique to using the main hospital operating room. So much so that 90% of hand surgeries in Canada are now performed in an office surgery suite. The advantages to this technique are many including:

DECREASED COST16684325_1312534472170808_5740088889949727544_n

Performing surgeries in-office cuts out many of the excessive facility and anesthesia fees associated with going to a hospital or surgery center. Studies have repeatedly shown approximately 80% decrease in costs when surgeries are performed in the office versus the hospital setting. A recent 2017 study published in the Journal of Hand Surgery compared the cost of doing common hand procedures such as carpal tunnel release, trigger finger release, and tendinitis release in the office versus in the hospital. The study revealed a savings of over $6000 dollars for carpal tunnel release and $4600 dollars for trigger finger release. In their study of only 100 patients they managed to save the health system over $393,000. If we extrapolated these numbers to all carpal tunnel surgeries performed in the US each year we could save the US health system approximately 3 billion dollars a year.  It is easy to see how WALANT could be major savings for those who are self pay or those with high deductibles and copays. This particularly applies to Medicare patients who are on fixed incomes. Remember, Medicare Plan B patients always pay a 20% copay on charges. Would you rather pay 20% of $600 or 20% of $6000?


According to Practice Greenhealth, hospitals in the US produce more than 5 tons of waste annually. Incinerated waste, such as that produced in hospitals, emits more CO2 per megawatt hour than a coal fired power plant. In addition, incinerated waste includes toxic metals such as mercury and cadmium. It is estimated that the hospital OR produces 30-33% of such waste. The Canadian experience shows that WALANT produces 1/10th of the medical waste as that produced in a hospital OR.


As extensive experience at plastic surgery, dental and Moh’s dermatology offices have proven, procedures performed in the office setting under local anesthesia are exceedingly safe. The local anesthesia itself is extremely safe and the infection rates are the same as those reported in hospitals. Also, remember that “the safest sedation is no sedation”, as with WALANT patients have full control over their airways and vital signs. This is particularly advantageous for those with heart or lung disease. In fact, office based surgery is so much safer that a patient doesn’t need to undergo any preoperative testing prior to surgery. Also, you won’t need to make changes to your medications, like holding your insulin or blood thinner.

LESS PAINNeedle Size

WALANT procedures are less painful than procedures performed in the operating room. Remember, the  20 G IV needle that is placed before hospital surgery is much larger than the small 27 or 30 G needle used to begin local anesthesia in the office. In addition, there are no veins to try and find as local anesthesia is administered without the need for venous access. Finally, there is no need for painful lab draws prior to surgery, as preoperative testing is not even necessary.


WALANT is much more convenient. No sedation means that in most cases  you can drive yourself to and from your surgical appointment. You don’t have to arrange a driver or even arrange a babysitter. No sedation also means you can eat or drink whatever you want right up to the time of surgery.  Lastly, you will only need to designate 1-2 hours to the surgical process versus 24-48 hours in the hospital. Overall, this WALANT is much less disruptive to your work and personal life.


Particularly in hand surgery, being able to assess the strength and glide of a tendon repair or transfer in an awake patient is key to getting good results. It is one thing to make a repair look nice in a sedated patient, but this means nothing if you can’t observe how the hand or fingers works. Awake assessment allows fine tuning of tendon and soft tissue surgery. This fact is why most hand surgeons in the US, and the world, are turning to WALANT.

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