The use of different size-hysteroscope in office hysteroscopy: our experience

Romani, Federica; Guido, Maurizio; Morciano, Andrea; Martínez, Daniela; Gaglione, R; Lanzone, Antonio; Selvaggi, Luigi

doi:10.1007/s00404-013-2932-7

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…According to the literature, the rate of non-completion of the office hysteroscopy process is 1.3–5.2%. 26 Thus the rate of failure in our study was acceptable. The “no-touch” technique is considered suitable, based on the number of successful office hysteroscopies in our practice.…”

Section: Discussionmentioning

confidence: 51%

Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial

Gülücü

Çakmak

2021

Ann Saudi Med

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BACKGROUND: Abnormal uterine bleeding (AUB) affects approximately 14% to 25% of women of reproductive age. The most common use of office hysteroscopy is to evaluate pathologies related to AUB and reproductive health, but office hysteroscopy can also be used for the diagnosis and treatment of other intrauterine pathologies. OBJECTIVE: Investigate the effects of the temperature of the distension fluid on pain severity in patients undergoing diagnostic office hysteroscopy due to AUB. DESIGN: Randomized controlled clinical trial. SETTING: Tertiary care center in Turkey. PATIENTS AND METHODS: One hundred perimenopausal patients with AUB were randomly allocated according to the temperature of the distension fluid used in office hysteroscopy (37°C or 25°C). Pain intensity was assessed using a visual analog scale (VAS). Six VAS measurements were compared over the course of the hysteroscopy: pre-treatment (VAS-1), at vaginal entry (VAS-2), at the cervical ostium transition (VAS-3), while in the cavity (VAS-4), at the end of the procedure (VAS-5), and 30 minutes after the end of the procedure (VAS-6). MAIN OUTCOME MEASURE: VAS SAMPLE SIZE: Fifty in each group enrolled, one drop out. RESULTS: The VAS-3, VAS-4, and VAS-5 scores were significantly lower for patients in the warm fluid group than in the room temperature group ( P <.05), whereas the VAS-1, VAS-2, and VAS-6 scores were similar in both groups. CONCLUSION: The application of warm distension fluid in office hysteroscopy reduces pain severity compared with the application of an unheated fluid. LIMITATIONS: The main limitations of the study were that a subgroup analysis could not be performed due to an insufficient number of cases, and we were unable to evaluate vasovagal symptoms. CONFLICT OF INTEREST: None.

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Section: Discussionmentioning

confidence: 51%

Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial

Gülücü

Çakmak

2021

Ann Saudi Med

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“…It's obvious that IV sedation might have precluded subjective pain assessment by the patients. In addition, the chosen warm temperature of 40°C is far from the physiological body temperature [11,12,14].…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers have mentioned greater intensity of pain at extremes of age and in cases that had undergone prior surgical cervical interventions. It is likely that colic triggered by uterine contractility could be provoked by cooler temperatures, which is considered hostile to the uterus [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Warm Saline Distension Media on Relieving Pain in Outpatient Office Hysteroscopy: A Randomized Controlled Clinical Trial

2019

JGRM

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Background: Outpatient hysteroscopy is the preferred examination procedure for diagnosis of intrauterine pathology and abnormal uterine bleeding causes, in addition for therapeutic operative management. It is desirable to apply as many procedures as possible with an office hysteroscopy, if they are implemented in a safe and effective fashion. Aim: Evaluation and investigation of the effectiveness of warm saline distensibility media in reducing the pain perceived in women undergoing diagnostic hysteroscopy procedure. Methodology: A randomized controlled clinical research trial that recruited 82 women scheduled for outpatient office hysteroscopy in Early cancer detection unit in Ain Shams Maternity Hospital from April 2017 till May 2018. Two research groups were categorized into warm saline and normal room temperature saline research groups each contained 41 cases. Comparative analysis of pain perceived in both groups was conducted to assess efficiency of warm saline to reduce pain perception. Results: Hysteroscopic findings didn’t differ significantly between the two groups, namely ease of introduction of hysteroscope, position of uterus and morphological appearance of the ectocervix, endocervical canal, endometrium, endometrial cavity, and tubal ostia. Also, no statistically significant differences were observed between the two groups in the duration of procedure. Parameters of pain assessment differed statistically significantly between the two research groups. p value <0.001 .Simple analysis of VAS scores revealed a statistically significantly lower VAS score at the end of the procedure in the warm distention medium group in comparison to the room-temperature distention medium group. The same finding remained constant after 15 minutes from the end of the procedure. Assessment of variation of VAS score with combined variation of temperature of distention medium over time was assessed using repeated measure ANOVA analysis. Patient satisfaction, indicated by the proportion of the patients who would undergo the hysteroscopic examination again by usage of same method, was statistically significantly higher in the warm distention medium research group in comparison to the room-temperature medium research group (89.74% vs 71.05% consecutively).(p value <0.04) Conclusions: Pain is measured by VAS score is statistical significantly lower at the end of the procedure in warm saline distension medium research group in comparison to room temperature distension medium research group (1.64+0.82vs 3.05+1.17) consecutively. Denoting possible effectiveness of warm saline in reducing pain perceived in office hysteroscopy

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“…At our institution, we adopted a specific EST based on detailed criteria, according to the clinical presentation. In fact, we classified ESTs as follows: (I) dilatation and curettage (D&C), performed in case of active uterine bleeding that usually prevents the view of the cavity; (II) outpatient biopsy with 5 mm Bettocchi’s hysteroscope, using either micro scissors and/or forceps ( 22 ), performed in case of anesthesiological contraindication; (III) diagnostic hysteroscopy with 5 mm Bettocchi’s hysteroscope followed by D&C, performed in case no suspicious endometrial area was found for selective biopsy; (IV) operative hysteroscopy with cervical dilatation, using saline solution for uterine distention and resectoscope, performed in all the remaining cases and, finally; (V) operative hysteroscopy with cervical dilatation, performed as previously mentioned and followed by D&C, in case of subjective impression of scanty material obtained after resectoscopic biopsy. All procedures, except outpatient hysteroscopy, were performed under general anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Impact of endometrial sampling technique and biopsy volume on the diagnostic accuracy of endometrial cancer

Ferrari¹,

Forte²,

Arrigoni³

et al. 2020

Transl Cancer Res TCR

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Background: Histotype and tumor grading of endometrial cancer are the most important factors that have to be assessed by preoperative endometrial sampling, and their concordance with the final surgical and definitive histological findings is of paramount importance. We aim to compare histotype and tumor grading concordance of various endometrial sampling techniques (ESTs) and to investigate the role of endometrial volume biopsy.Methods: We performed a retrospective analysis of patients with apparent early stage endometrial cancer collecting demographic, clinical data, type of EST, pathological characteristics of endometrial biopsies and final specimens. We classified ESTs as dilation and curettage (D&C), diagnostic hysteroscopy with D&C, outpatient hysteroscopy and operative hysteroscopy with or without D&C. Diagnostic and operative hysteroscopy were performed with Bettocchi's 5 mm hysteroscope. We evaluated concordance for histotype, and tumor grading, and we performed subgroup analysis based on the technique and final tumor grading. Concordance was classified from good, moderate, sufficient, fair, poor and none using Cohen k-statistic. Finally, we investigated the existence of independent risk factors for discordant tumor grading using multivariate binary logistic regression.Results: We collected 148 patients and of these 131 (88.5%) were diagnosed with endometrioid histotype and 65 (44%), 46 (31%) and 37 (25%) respectively with well, moderate and poor differentiated tumors. Atypical hyperplasia (AH) was detected preoperatively in 28 patients (19%). Histotype concordance was fair (k=0.35) and tumor grading concordance was moderate (k=0.45); particularly, concordance was fair in welldifferentiated cases (k=0.38); concordance was moderate in moderate-and poor-differentiated cases (k=0.52) and good (k=0.71). Operative hysteroscopy showed moderate concordance for histotype (k=0.41), while grading concordance was fair for G1 (k=0.41), moderate for G2 (k=0.58) and good for G3 (k=0.72), regardless the use of D&C. Preoperative volume biopsy did not impact the concordance of tumor grading, while the adoption of operative hysteroscopy (with or without D&C) decreased the risk of grading discordance in G3 tumors (HR 0.17; 95%

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The use of different size-hysteroscope in office hysteroscopy: our experience

Abstract: Our result suggests that the hysteroscope size plays a pivotal role in the acceptance and for the success of office hysteroscopy.

Cited by 12 publications

References 21 publications

Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial

Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial

Effectiveness of Warm Saline Distension Media on Relieving Pain in Outpatient Office Hysteroscopy: A Randomized Controlled Clinical Trial

Impact of endometrial sampling technique and biopsy volume on the diagnostic accuracy of endometrial cancer

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