Pain management for in-office hysteroscopy. A practical decalogue for the operator

Vitale, Salvatore Giovanni; Pacheco, Luis Alonso; Haimovich, Sergio; Riemma, Gaetano; Angelis, Maria Chiara De; Carugno, Josè; Lasmar, Ricardo Bassil; Sardo, Attilio Di Spiezio

doi:10.1016/j.jogoh.2020.101976

Cited by 22 publications

(19 citation statements)

References 57 publications

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“…The hysteroscopic removal of misplaced IUD, or fragments of it, was categorized as easy by the majority of gynecologists participating in this survey. Moreover, the minimal patient's discomfort and the high success rate of retrieval with in-office hysteroscopy without anesthesia reveals that is a feasible and effective approach for the retrieval of an IUD with not visible strings [19,23,24].…”

Section: Discussionmentioning

confidence: 99%

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

et al. 2022

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To investigate about the opinions of gynecologists regarding the in-office hysteroscopic removal of retained or fragmented intrauterine device (IUD) without anesthesia. An online survey was made available to gynecologists who routinely performed in-office hysteroscopy. Five areas of interest were analyzed: average number of hysteroscopic procedures performed without anesthesia, availability on their local market of the different types of hormonal and non-hormonal IUDs, reasons for the hysteroscopic removal of the IUD, types of IUDs that were more commonly found retained or fragmented and, overall difficulty of the hysteroscopic removal. A total of 419 surgeons voluntarily responded the survey, of which 19 were excluded for not performing in-office hysteroscopy. The most commonly available IUD was the Levonorgestrel-based Mirena (Bayer Healthcare, Germany) or similar, (399/400, 99.7%), followed by Copper T (Paragard, CooperSurgical INC, United States) (397/400, 99.2%), Multiload (234/400, 58.5%) and Jaydess (Bayer Healthcare, Germany) (227/400, 56.7%). The intracavitary retention of the IUD with (44.5%, 178/400) and without (42.2%, 169/400) visible strings accounted as the most common reason for undergoing hysteroscopic IUD removal. Copper T IUD was the most common intracavitary retained (297/400, 74.2%) as well as fragmented device (236/400, 59.9%). The in-office hysteroscopic removal of the IUD was considered an easy procedure by almost all the operators (386/400, 96.5%). In-office hysteroscopy without anesthesia is seen as a feasible and easy approach to remove retained or fragmented IUDs inside the uterine cavity or cervical canal. While the Levonorgestrel-based IUD is the most commercialized, Copper T IUDs are the most commonly found retained or fragmented.

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Section: Discussionmentioning

confidence: 99%

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

et al. 2022

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“…Anxiety, manifesting as pain, can be in uenced by various factors, including cervical dilatation, intrauterine pressure, manipulation, and emotional states [37][38][39]. Multiple strategies can alleviate this anxiety, such as reducing waiting times and procedure duration, along with non-pharmacological methods like music listening, providing continuous procedural updates, or enabling the patient to watch the procedure on a monitor [40][41][42][43]. Doctor-patient communication and patient education have been identi ed as practical non-pharmacological tools to reduce preoperative anxiety and improve patient satisfaction [44,45].…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopy in the new media: quality and reliability analysis of hysteroscopy procedures on YouTubeTM.

Libretti,

Vitale,

Saponara

et al. 2023

Preprint

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Background Hysteroscopy plays a crucial role in diagnosing and managing various intrauterine pathologies. However, its execution can be influenced by patients' perception and understanding, which are often shaped by digital resources such as YouTube™. Given its popularity and accessibility, YouTube™ has the potential to greatly influence patients' knowledge and expectations about this procedure, highlighting the need for accurate and reliable information. Purpose This study aims to assess the reliability and quality of hysteroscopy information available to patients on YouTube™. Understanding the nature of information patients’ access can help address their fears and potential misunderstandings about the procedure, consequently reducing the likelihood of suspension or postponement due to anxiety. Methods A comprehensive analysis of YouTube™ was conducted, simulating the search process of a patient seeking information about hysteroscopy. The study evaluated the reliability and quality of 90 out of the first 100 hysteroscopy-related videos on YouTube™, scored by four gynecologists – two experienced hysteroscopists and two trainees. The videos were assessed for reliability and quality using the mDISCERN and Global Quality Scale (GQS) scores. Results The average mDISCERN and GQS scores for the evaluated videos were below the optimal 3 points, highlighting the lack of fluency, comprehensiveness, and reliability of the available information. Notably, while videos produced by experts, including doctors and professional channels, had higher scores, they still fell short of the minimum score of 3. These videos also weren't considered more suitable for either patients or trainees. Videos that were assessed as reliable (mDISCERN ≥ 3) were observed to be longer and were more frequently produced by doctors. These videos were suggested more to trainees rather than patients. Similarly, videos deemed as fluent and comprehensive (GQS ≥ 3) were longer and were more often recommended to patients. Conclusions While YouTube™ is a widely used source of medical information, the quality and reliability of hysteroscopy videos on the platform are poor. The strategic use of selected, high-quality hysteroscopy videos can enhance procedure success and alleviate patient fears. However, the unsupervised discovery of information by patients could potentially lead to procedure failure or an elevated level of stress due to misleading or incorrect information.

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“…The results of this case series provide the indication that RA could be considered a valid alternative to GA, not only for minimally invasive and short-term gynecological procedures [ 31 ], but even for longer and more complex gynecological surgery such as hysterectomy procedure. This represents a convincing result, especially if it is considered that a recent review with meta-analysis has demonstrated no significant advantages to using SA over GA for laparoscopic treatment of benign gynecological diseases [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive anesthesia for laparoscopic hysterectomy: a case series

Corte

Mercorio

Palumbo

et al. 2022

Arch Gynecol Obstet

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Purpose Regional anesthesia (RA) is considered as a “minimally invasive technique” to achieve anesthesia. To assess the feasibility and the perioperative outcomes of laparoscopic hysterectomy in regional anesthesia from the point of view of the surgeon, anesthesiologist and patient. Methods A retrospective search was performed to identify patients who underwent laparoscopic hysterectomy under RA from April 2020 to September 2021. Five patients affected by benign gynecological disease (atypical endometrial hyperplasia or uterine leiomyomas) were included. Results The postoperative pain, nausea, and vomiting (PONV) and the antiemetic/analgesic intake were evaluated. Postoperative surgical and anesthesiological variables were recorded. Duration of surgery was 84 ± 4.18 and no conversion to GA was required. According to VAS score, the postoperative pain during the whole observation time was less than 4 (median). A faster resumption of bowel motility (≤ 9 h) and patient’s mobilization (≤ 4 h) were observed as well as a low incidence of post-operative nausea and vomit. Early discharge and greater patient’s satisfaction were recorded. Intraoperatively pain score was assessed on Likert scale during all the stages of laparoscopy in RA, with only 2 patients complaining scarce pain (= 2) at pneumoperitoneum. Conclusion RA showed to have a great impact on surgical stress and to guarantee a quicker recovery without compromising surgical results. RA technique could be a viable option for patients undergoing laparoscopic hysterectomy.

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Pain management for in-office hysteroscopy. A practical decalogue for the operator

Cited by 22 publications

References 57 publications

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

Hysteroscopy in the new media: quality and reliability analysis of hysteroscopy procedures on YouTubeTM.

Minimally invasive anesthesia for laparoscopic hysterectomy: a case series

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