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Office Based Hand Surgery


Office Based Hand Surgery(also called WALANT)refers to performing hand surgery in an office

based operating suite. At Graham Plastic Surgery we have a state of the art office operating room for performing hand and skin surgeries under local anesthesia, sometimes supplemented with nitrous oxide gas.


accordance with the ASSH(American Society for Surgery of the Hand) Lean and Green Initiative, this conscientious technique offers surgery with 80% less cost and 1/10th of the medical waste production.  This is a very safe and established technique. In fact, in Canada 90% of hand and skin surgeries are now performed in an office surgery suite.


      • According to Practice Greenhealth, hospitals in the US produce more than 5 tons of Office Based Hand Surgerysolid waste annually. This waste goes into our landfills and oceans. In addition, 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 office based surgery produces 1/10th of the medical waste as that produced in a hospital OR.


      • Performing surgeries in-office cuts out many of the excessive facility and anesthesia fees associated with going to a hospital or surgery center. 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.  It is easy to see how office based surgery could be major savings for those who are self-pay or those with high deductibles and copays.
        Office Based Hand Surgery
    • SAFETY
      • 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 local anesthesia alone 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 PAINOffice Based Hand Surgery
      • Office based procedures are actually 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.
      • Office Surgery 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.
    • 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 surgery under local anesthesia.


Hand Surgery Rochester NY