Objective To evaluate whether vaginoscopy or standard hysteroscopy was more successful in the outpatient setting. Design Randomised controlled multicentre trial. Setting Outpatient hysteroscopy clinics at two UK hospitals. Population 1597 women aged 16 or older undergoing an outpatient hysteroscopy. Methods Women were allocated to vaginoscopy or standard hysteroscopy using third party randomisation stratified by menopausal status with no blinding of participants or clinicians. Main outcome measures The primary outcome was ‘success’, a composite endpoint defined as: a complete procedure, no complications, a level of pain acceptable to the patient, and no sign of genitourinary tract infection 2 weeks after the procedure. Results Vaginoscopy was significantly more successful than standard hysteroscopy [647/726 (89%) versus 621/734 (85%), respectively; relative risk (RR) 1.05, 95% CI 1.01–1.10; P = 0.01]. The median time taken to complete vaginoscopy was 2 minutes compared with 3 minutes for standard hysteroscopy (P < 0.001). The mean pain score was 42.7 for vaginoscopy, which was significantly less than standard hysteroscopy 46.4 (P = 0.02). Operative complications occurred in five women receiving vaginoscopy and 19 women receiving standard hysteroscopy (RR 0.26, 95% CI 0.10–0.69). Conclusions Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy and therefore should be considered the technique of choice for outpatient hysteroscopy. Tweetable abstract Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy.

The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting.

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(Abstracted from BJOG 2019;126:891–899) Hysteroscopy is one of the most commonly used tests in gynecology. It is used in the diagnosis of abnormal bleeding, reproductive problems, and endometrial cancer.

This complete enumeration, cross-sectional comparative study was conducted to compare the scores obtained by students in traditional practical examination with that obtained in objective structured practical examination in Osteology, which is a "must know" component of the first-year MBBS curriculum in Anatomy. After obtaining permissions from the Institutional Ethics Committee and institutional authorities for conducting the study, first-year MBBS students were oriented about the purpose of the study, the objective structured practical examination procedure, the checklist based marking system and their written informed consent was obtained. The maximum marks obtainable in both traditional practical examination and objective structured practical examination were 10 marks each. A total of 55 (27 females; 49.09% and 28 males; 51.91%) first-year MBBS students participated in the study. The students obtained higher scores in objective structured practical examination, as compared that in traditional practical examination. The male students had a higher maximum score in traditional practical examination but the gender difference in scores was not significant either for traditional practical examination (p=0.054) or for objective structured practical examination (p=0.934). Students obtaining relatively lower scores would require remedial training. A larger study would be necessary in order to generalize the results.

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