Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain

Cooper, Natalie Am; Smith, P; Khan, Khalid S.; Clark, T. Justin

doi:10.1111/j.1471-0528.2010.02613.x

Cited by 35 publications

(58 citation statements)

References 6 publications

(6 reference statements)

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“…Serious complications in the office setting such as uterine perforation are rare, but vaso-vagal reactions have been reported to complicate between 2.3 and 9.0% of procedures. 2,7,8 For the purpose of this trial, vaso-vagal reactions were defined clinically as a woman being unable to leave the operating couch within 5 minutes of cessation of the procedure due to feeling faint, dizzy or nauseous. Procedural pain and patient acceptability were collected on an iPad mini TM (Apple TM , Cupertino, CA, USA) device.…”

Section: Methodsmentioning

confidence: 99%

“…One technical modification identified to potentially reduce pain from hysteroscopy is 'vaginoscopy', otherwise known as the 'no touch' technique. [2][3][4] This describes a method where the hysteroscope is guided into the uterus without the need for potentially painful vaginal instrumentation. Miniaturisation of hysteroscopes has facilitated the development of this approach because resistance to advancement of the hysteroscope through the cervical canal is minimised.…”

Section: Introductionmentioning

confidence: 99%

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Vaginoscopy Against Standard Treatment: a randomised controlled trial

Smith

Kolhe

O’Connor

et al. 2019

BJOG

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vaginoscopy Against Standard Treatment: a randomised controlled trial

Smith

Kolhe

O’Connor

et al. 2019

BJOG

Self Cite

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“…The pain is related to the diameter of the hysteroscope, the use of saline instead of CO 2 for distension [ 69 , 70 ], the use of vaginoscopic approach without speculum, parity and surgeon skills. Cooper et al [ 71 ]. examined the effect of a vaginoscopic approach to outpatient hysteroscopy on the patients' experience of pain, compared with a traditional approach using a vaginal speculum and tenaculum in a metaanalysis of six RCTs (n = 1,321 The myomectomy techniques that can be performed in an offi ce setting without anesthesia are the 2-step procedure with laser and in some cases morcellation (the new Trucelar system for 5 mm hysteroscope).…”

Section: Offi Ce Setting -Outpatient Vs Inpatientmentioning

confidence: 98%

Hysteroscopic Myomectomy

Haimovich¹,

Eliseeva²,

Mynbaev³

2014

Uterine Myoma, Myomectomy and Minimally Invasive Treatments

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“…Because additional interventions and instruments are required, providing endometrial biopsy during the procedure is both difficult and uncomfortable. 29,30 The H Pipelle device (Figure 3d) has been developed based on the Pipelle to facilitate endometrial sampling after "no touch" hysteroscopy and it obtained an adequate endometrial biopsy without the need for additional instruments such as vaginal speculum and tenaculum. 31,32 Nqu et al compared the efficiency in evaluation of the endometrial cavity of vaginoscopic hysteroscopy using the H Pipelle with traditional hysteroscopy using the standard Pipelle.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%