Raising the Bar: Office-Based Surgery as an Artist’s Surgical Spa

As a surgeon committed to excellence, I have always believed that surgery is not just a procedure – it is an art, an experience, and an opportunity to elevate human vision beyond the ordinary.

Over the years, I have had the opportunity to compare the experiences of patients who had one eye operated in a traditional surgical center and the other corrected in my office-based surgical suite. Their feedback has been strikingly consistent. Patients describe the difference as “night and day,” not only in comfort and experience, but also in terms of their visual outcomes.

Although hospital settings and ambulatory surgical center models can be effective environments for patient care, I have always believed that the future lies in a more personalized/tailored and more premium form of patient care.

Our practice does not advertise specific technology, or do any discounts or deals, and neither do we market our office-based surgical suite – instead we simply have a genuine desire to raise the patient’s experience.

Reinforcing my belief in this approach is the caliber of my clientele. Many of my patients travel from across the nation and world, and are among the most demanding, highly educated, and well-prepared individuals. They arrive with high expectations, having studied every possible option for their eye surgery, often after surgical experiences elsewhere. They are not just seeking treatment – they are seeking perfection.

I have had the privilege of operating on patients who, as architects themselves, have built and run successful surgical centers. These individuals understand every aspect of construction, surgical workflows, technology, and efficiency. And yet, when it came to their own eyes, they chose my office-based surgical suite. Similarly, I have performed surgery on healthcare professionals who have been responsible for maintaining quality control and safety protocols in hospitals and ambulatory surgical centers. Despite this exposure, they praised the quality, safety, and protocols of our office-based surgical suite. This speaks volumes – not only about confidence in an office-based surgical model, but also about the reality of what a surgical experience should be.

A concept rooted in proven success
 

While office-based surgery may seem like a modern innovation, to me it is simply "old wine in a new bottle." It is not a new or untested idea – it is a refined and evolved version of a time-tested approach. Growing up and training in India, I witnessed first-hand how eye surgery was routinely performed in office-based surgical settings. In many cases, this was done to possibly overcome real estate factors, bureaucracy, and gain more control for an optimized surgical workflow. The concept worked flawlessly, with relative safety, excellent surgical skills, precision, and care.

Having trained in that model, I never questioned its viability. I knew from experience that it worked. So when I transitioned to an office-based surgical suite in the US, I was not conducting an experiment – I was simply bringing back a proven, effective, and patient-focused model, but raising the bar further – to a futuristic surgical spa.

What is often overlooked is that in the past, surgery was considered a craft – a delicate, personalized experience between the surgeon and patient, free from the constraints of mass production. Office-based surgery brings back that lost art, merging the best of both worlds: the time-honored patient-centered approach with today’s highest level of precision, technology, and safety standards.

This is not a departure from surgical tradition; it is a return to its roots – only now, enhanced with the world’s most advanced techniques and innovations.

How an office-based surgical suite elevates surgery
 

A waltz, not a disco

Surgery in a high-volume center may feel like a disco – fast-paced, chaotic, and impersonal, with multiple cases being shuffled in and out simultaneously. In contrast, surgery in an office-based suite is more like a waltz – a harmonious, fluid, and elegant experience where every movement is deliberate, and the connection between surgeon and patient is intimate and uninterrupted. The surgeon can connect with a patient's heartbeat, sense their reactions, and operate with complete control and calm. In our suite, there is no sense of detachment – each surgery is a custom-designed process, where the patient is a part of the journey and not just a number on a schedule.

Complex surgeries are more than possible – they thrive

Even the most intricate procedures can be performed with the highest level of precision, control, and patient satisfaction. With complete autonomy over my surgical environment, I can perform highly advanced procedures with the same – if not greater – level of precision as in a hospital setting.

Patients who have endured anxiety, discomfort, and inefficiency in larger institutions are often surprised by how seamless, reassuring, and pleasant their experience can be – even when coming in for complex procedures. With state-of-the-art instrumentation and a meticulously customized workflow, even the most advanced surgeries can be executed with unparalleled precision and patient comfort.

Despite having a range of monitored anaesthesia levels for patients, we started with sublingual midazolam, ketamine HCl, and ondansetron (MKO), and progressed to 5 milligram diazepam, before eventually progressing to nothing besides numbing drops. Interviewing patients after their procedure, we found that all preferred the no-medication, topical numbing drops for their cataract surgery.

Of course, patients with medical comorbidities have to be identified and excluded from office-based surgery options. But in this setting the surgeon is highly alert to the patient’s ability to make proper judgments.

Aesthetic and sensory precision

My approach extends beyond technical precision to include lighting, music, ambiance, and even the colors of my surgical scrubs and personally invented surgical instruments, all of which enhance both surgical precision and the emotional experience for my patients.

• Customized lighting to match the patient’s journey:
  • Green lighting with my signature apple green surgical instruments for military patients, symbolizing resilience and strength.
  • Fuchsia lighting and instruments for breast cancer survivors, representing courage, hope, and empowerment.
  • Soothing blue or violet tones for highly anxious patients, creating a calming effect that enhances their surgical experience.
     
• Customized surgical instrumentation, e.g., the GNi® instrument, which changes the century-old hand-held instrument paradigm from vertical inefficiency to horizontal, single-instrument surgery, along with color-coded sets for different surgeries and patient journeys/events. (Innovation does not stop in an office-based surgical suite; indeed, it can be informed and enhanced in such an environment. The GNi® was conceived in my surgical spa to make the surgery even more elegant and to reduce the clutter of instruments on the surgical tray.)

My experience

I’ve always known that patients actually want to help their surgeons. This has been repeatedly proven right when certain extremely complex cases took longer or I had to perform additional maneuvers. Patients from cultures all over the world have wanted to be a “team mate” and for me to succeed. In many such cases I would interview the patient after surgery to ask if they would have liked more anesthesia or whether they felt any pain, and the answer was unanimously no.

In everyday videos that we share with eye surgeons globally, I keep showing how patients are responding and talking gently while I am still operating inside their eye. For example, in the case of a pastor with a baritone voice, he sang the “Amazing Grace” while I was still inside his eye operating, which highlights the comfort and confidence not only of the doctor, but also of the patient, who could let go of anxiety and enjoy the experience.

Being close to the patient from preoperative to surgery to postoperative makes them feel comfortable and relieves anxiety; additionally, seeing the faces in surgery of the staff they have seen in the office can be a further comfort to them.

The “cost” of office-based surgery

The luxury for the surgeon of being in control of your schedule and patient-care style comes at the cost of being responsible for everything, from the carpet outside the office to the lens implant in the patient’s eye, and every detail that could possibly impact their experience and visual outcomes. But this is indeed our responsibility, and it needs to be welcomed when  performing at this high level of delivery.

I want to emphasize that any eye surgeon who is already good at what they do will become even more artistic, sensitive, and focused in an office-based setting. Since the connection to the patient is very close, and the responsibility for the experience and outcome rests wholly on the surgeon's shoulders, efficiency becomes a welcome side effect of the elevated surgical performance.

The staff and surgeon get used to regular compliments from patients, who love the fact that they're walking into surgery without a stretcher or embarrassing open gowns or painful needle pricks, and enjoying a spa-like experience, topped by walking out of surgery fully conscious and aware of their surroundings. And the staff and practice also benefit from being involved in the entire circle of care from the minute a patient arrives at the office until they leave after post operative evaluations.

A new standard for surgical excellence

I have helped design and encouraged numerous eye surgeons nationally and around the world to take this route, and they are flourishing. To me, surgery is not just about skill, it is about art, elegance, and an immersive experience. I see the bigger picture – how lighting, color, environment, and even the instruments themselves contribute to the patient’s experience and confidence. When even my most skeptical and demanding patients walk away feeling not just satisfied but transformed, I know that I have not only corrected their vision but have also redefined what a surgical experience should be.