moved healthier
patients scheduled to
undergo straightfor-
ward procedures to
the office, but she then
tackled more
advanced cases as her
confidence and com-
fort level grew. She
now dedicates a single
afternoon each week
in her office to per-
form 3 or 4 sinus pro-
cedures, including
submucous reduction
inferior turbinates, bal-
loon dilation, maxil-
lary antrostomy, ante-
rior ethmoidectomy
and nasal polypectomy.
Smaller instrumentation, 3-mm endoscopes and advances in local
anesthetic techniques have made tailoring the procedures to the office
setting possible. Patients take an oral anxiolytic as soon as they arrive.
Dr. Perkins then starts slowly advancing pledgets containing topical
numbing medicine inside the nose. After waiting about 20 minutes for
the numbing to take effect, she injects a local anesthetic and begins
the procedure. Importantly, patients begin applying a topical deconges-
tant every 30 to 60 minutes on the morning of surgery. That eases the
application of the topical numbing medication. Using local anesthesia
J U N E 2 0 1 6 • O U T PA T I E N T S U R G E R Y. N E T • 1 0 1
• HELPING HAND Robotics could dramatically improve
how surgeons train and perform.
Johns
Hopkins
University
