The ability to visualize changes within tissue during surgical procedures will improve feedback to the surgeon permitting intraoperative adjustments in protocol. Optical coherence tomography (OCT) is a biomedical imaging technology based on the detection of near-infrared optical backscatter from tissue. Fast scanning optical coherence tomography, capable of imaging at 8 frames per second, is introduced for real-time monitoring of surgical interventions with micron-scale resolution. Ablation and thermal effects of argon laser exposure are examined in different tissues, illustrating one example of an interventional procedure. Integration of high-speed OCT imaging with an incisional or ablative device suggests that this technology may be useful for assessing intraoperative dynamics of tissue ablation.