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

The gynecologist's office was, historically speaking, the original setting for surgical practice. In 1809, Ephraim McDowell performed the first ovariotomy and removed a 22.5-pound tumor from Jane Crawford in his Danville, Kentucky office-decades before the development of anesthesia or the aseptic technique. Three developments-introduction of surgical anesthesia, improved operative techniques, and the evolution of the medical-economic environment-shaped surgical practice for over two centuries. The latter part of the 20th century also brought two dramatic changes that affected gynecologic practice. The first included social changes which created a demand for legalized abortion and elective sterilization. The second was a cascade of technological growth and innovations that created the field of minimally invasive gynecologic surgery (MIGS), allowing many procedures to be transferred from the hospital to the outpatient setting and then to the office. With the increasing demand for patient-centered care, effective operating room utilization, and the efficient use of physicians' time, many gynecologic procedures are now being performed in an office-based setting. But, at least three important obstacles remain: the need for widespread accreditation, the availability of teaching in an office-based environment, and meeting the ethical obligation for adequate analgesia and sedation in an office environment.