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Out of the OR, into the Office

How UH is bringing gynecologic procedures into the office setting, and what it means for patients

Innovations in Obstetrics & Gynecology - Spring 2018

Donna Plecha, MD


Residency Program Director, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center; Associate Professor, Reproductive Biology, Case Western Reserve University School of Medicine

Many common gynecologic procedures have been traditionally performed in a surgical setting with general anesthesia, but that trend is starting to change. Physicians across the country are bringing procedures like endometrial polyp removal and sterilization into the office – and University Hospitals Cleveland Medical Center is at the forefront of this trend.

Kimberly Gecsi, MD, Obstetrics and Gynecology Residency Program Director at UH Cleveland Medical Center and Associate Professor of Reproductive Biology at Case Western Reserve University School of Medicine, has been performing innovative procedures in the office for 10 years.

The benefits of in-office procedures are clear, Dr. Gecsi says. Patients do not need anesthesia in an office setting, which means they do not need to worry about the associated risks. They can have life-improving procedures performed in a space they are comfortable in and return to their lives much faster. Many patients may also appreciate the in-office approach for financial reasons. It is more cost-effective for patients to undergo a procedure in an office setting than in an operating room.

Based on these advantages, transitioning some procedures out of the hospital operating room and into the office seems like a logical step. Still, physicians and health systems need to be prepared to do so. “You must be comfortable with the procedure and performing it on a patient who is awake,” Dr. Gecsi notes.

Physicians also need a trusted staff that is trained in preparing patients for in-office procedures, and hospitals and health systems must supply their physicians with all necessary equipment to perform these procedures in the office.

Here are some of the innovative gynecologic procedures UH is bringing into the office.

Hysteroscopy – Physicians use hysteroscopy to diagnose and treat various intrauterine pathology, such as endometrial polyps. UH physicians such as Dr. Gecsi can perform this procedure, as well as endometrial ablation, in the office without using general anesthetic.

FemBloc – UH Cleveland Medical Center is currently participating in a prospective, multicenter, international, non-randomized, two-armed study of FemBloc, an in-office procedure also known as bilateral tubal sterilization.

“FemBloc is a biopolymer that is placed in the entry of each fallopian tube,” Dr. Gecsi says. “The placement is then confirmed with an ultrasound.”

This permanent, non-hormonal sterilization procedure can be performed with minimal discomfort for patients. The study will last 65 months, while the control group portion of the study will last 62 months.

diVa laser – UH is in the process of purchasing diVa technology. This Hybrid Fractional Laser (HFL) technology can safely and comfortably treat numerous different conditions in the office, including:

  • Vulvovaginal atrophy: a condition that causes symptoms such as dryness, soreness and pain, usually in menopausal women. 
  • Lichen sclerosus: a condition that can occur in postmenopausal women and causes thin patches of skin and discomfort.

“The diVa laser is going to provide us with another way to treat patients with vulvovaginal atrophy, a common problem among women that is traditionally treated with hormonal medications,” Dr. Gecsi says. “This office procedure can also treat vulvar pain and possibly urinary incontinence.”

The technology also gives patients a method to treat gynecologic conditions that may seriously affect quality of life without the use of hormonal medications.

UH Cleveland Medical Center is still working to acquire diVa technology, though some of its clinicians have already trained on the technology and are prepared to perform procedures with the diVa laser in the office setting. In line with the organization’s commitment to research and innovation, UH clinicians are preparing to conduct clinical trials centered on this technology and additional conditions it can treat.

Dr. Gecsi says UH continues to look ahead and identify ways to bring innovative procedures such as hysteroscopy, FemBloc and the diVa laser into the office, a setting where patients’ trusted providers can efficiently perform procedures without anesthesia.

“The future of medicine is in the ambulatory setting,” she says. “As UH continues to expand its ambulatory offices and studies, it is very exciting that we can treat more patients closer to home in a lower cost, potentially safer, and efficient setting.”

Contact Dr. Gecsi at