Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures.

Abstract

Introduction: Hysteroscopy is the gold standard for diagnosis and treatment of uterine pathologies. The office setting seems to be safe, reducing the anesthesia risks and also decreasing the overall costs of the procedure. Recent literature suggests that hysteroscopy performed without anesthesia may not be as painless as it was previously considered. Moreover, not every patient can be referred for a hysteroscopy in an office setting. Aim: To analyze the factors correlated with a successful hysteroscopy in an office setting. Material and methods: We analyzed the documentation of 1301 patients who underwent hysteroscopy at our department in the period 2013-2016. The impact of the type of the procedure and the various demographic factors on the need for general anesthesia was assessed. Results: Almost 80% of all hysteroscopies were performed without analgesia in an office setting. The remaining patients underwent a hysteroscopy in general anesthesia. The key aspect for successful office hysteroscopy is the scope of the performed surgery. Over 91% of diagnostic hysteroscopies have been done without analgesia, but only about 30% of extensive endometrial scratching procedures were performed in an office setting. A previous vaginal delivery increases the chances for a successful office hysteroscopy by about 21%, and in the case of diagnostic procedures, multiparous patients were at an about 79% lower risk of analgesia necessity. Conclusions: It is possible to perform nearly all diagnostic hysteroscopies in an office setting. In the case of operative hysteroscopy, the most crucial factor is the scope of the procedure.

Does “no-touch” technique hysteroscopy increase the risk of infection?

“…The reasons for not completing the hysteroscopic procedure with the vaginoscopic approach include pain, anxiety, cervical stenosis, excessive flexion of the cervix, vasovagal reaction, a retroverted uterus and adhesions ( 5 , 7 , 18 ) . Between 83% and 98% of diagnostic procedures can be successfully performed with office hysteroscopy ( 7 , 8 , 13 , 19 , 20 ) . However, there are studies reported that the success of outpatient hysteroscopy varies between 44% and 99.5% ( 21 , 20 , 23 ) .…”

“…Between 83% and 98% of diagnostic procedures can be successfully performed with office hysteroscopy ( 7 , 8 , 13 , 19 , 20 ) . However, there are studies reported that the success of outpatient hysteroscopy varies between 44% and 99.5% ( 21 , 20 , 23 ) . In this study, the failure rate for all outpatient hysteroscopy procedures was 3.6%, which is lower than 10% reported in the previously ( 24 ) .…”

Evaluation of Stress Hormone Levels, Preoperative Anxiety, and Information Needs before and after Hysteroscopy under Local Anesthesia in Relation to Transvaginal Procedures under General, Short-Term Anesthesia

“…Thanks to the development of minimally invasive techniques, which allow examining individual body cavities, the cervical canal and the uterine cavity can be viewed using small instruments. The use of mini-hysteroscopy, both in reproductive and in peri-and postmenopausal patients, is currently the "gold standard" due to the short hospital stay, short recovery time, integration of clinical practice with the "see and treat" mode, and reduction in the need for additional interventions, such as the need for general anesthesia and performing the procedure in the operating room [1][2][3][4][5]29,30]. Despite the tremendous advances made in mini-hysteroscopy over the past 20 years, many women still experience discomfort and pain in various stages of this procedure, which is the most common factor for treatment discontinuation [31,32].…”

“…Different stages of mini-hysteroscopy can result in different unpleasant sensations [38][39][40] and different intensities of pain; for example, women who had previously given birth by natural means usually perceive the passage of the hysteroscope through the cervical canal as less painful and the time of the procedure as shorter [29,41,42] or the pain level reported by them 60 minutes after procedure is lower [43]. Among the pain relief methods worth citing are the results of a randomized clinical trial conducted in 2021 by Gulucu et al [44] in which they compared the severity of pain in two groups of women, depending on the temperature of the distension fluid used in the office hysteroscopy (37 °C vs 25 °C).…”

Too big? A review of methods for removing large endometrial polyps in office minihysteroscopy - broadening the indications for the procedure in the COVID-19 pandemic.

“…In the case of difficulties extracting large tissue fragments, the newly introduced Cryoprobe seems to be the best option. Each of the methods described above has its specific applications, but thanks to their mutual complementation, we are now able to excise almost every lesion from the uterine cavity in an outpatient setting [19].…”