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Nguyen DB, Gerber VEM, Suen MWH, Flaxman TE, Singh SS. Outpatient hysteroscopy is effective for uterine cavity evaluation following failed office-based endometrial biopsy. J Obstet Gynaecol Res 2022; 48:2452-2458. [PMID: 35706346 DOI: 10.1111/jog.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 04/25/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Failure to obtain an office-based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room-based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost-effective, and safer alternative. However, there is no contemporary Canadian literature on the effectiveness of an outpatient approach for this specific population. OBJECTIVE We aim to evaluate the effectiveness and outcomes of outpatient hysteroscopy for uterine cavity evaluation for patients who have failed an in-office endometrial biopsy attempt. METHODS We conducted a retrospective cohort study of all patients referred to an academic outpatient hysteroscopy unit between January 2015 and January 2018, who underwent an outpatient hysteroscopy following failed endometrial biopsy. Data were collected from electronic medical records. RESULTS Of the 407 consecutive patients who underwent an outpatient hysteroscopic procedure, 68 met inclusion criteria. Postmenopausal bleeding was the most common indication for initial biopsy, and most failures were attributed to cervical stenosis. Outpatient hysteroscopies were successfully completed in 96% of cases (n = 65/68). Failure resulted from either anxiety and discomfort (n = 2), or severe intrauterine adhesions (n = 1). Overall, 10% of patients subsequently required an operating room-based hysteroscopy, either to complete a myomectomy or polypectomy, or to allow general anesthesia. Outpatient hysteroscopy identified endometrial hyperplasia and cancer in 4.5% and 3% of patients, respectively. CONCLUSION Outpatient hysteroscopy following unsuccessful office endometrial biopsy attempts appears to be a feasible, safe, and cost-effective investigation strategy that may prevent the need for an operating room-based procedure in 90% of cases.
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Affiliation(s)
- Dong B Nguyen
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael W H Suen
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa E Flaxman
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada
| | - Sukhbir S Singh
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Tagliaferri V, Ricciardi L, Ricciardi R, Pinto LR, Lanzone A, Scambia G, Guido M. Carbon dioxide in office diagnostic hysteroscopy: An open question. A multicenter randomized trial on 1982 procedures. Eur J Obstet Gynecol Reprod Biol 2019; 235:97-101. [DOI: 10.1016/j.ejogrb.2018.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
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3
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Carabias P, Celades-Filella M, Zapardiel I, Alsina-Maqueda A, Genover-Llimona E. Experience and results of office hysteroscopy at a primary hospital. J OBSTET GYNAECOL 2013; 34:54-6. [PMID: 24359051 DOI: 10.3109/01443615.2013.782277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our aim was to analyse, retrospectively, the perioperative outcomes of 3,488 office hysteroscopies. Age, menopausal status, parity, medical indications, use or not of anaesthesia, incidents, presence of pathology in the cavity, endometrial pathology, type of surgery and pain assessment details were collected. The mean age of patients was 52.1 years. The most common medical indication was suspicious ultrasound for endometrial disease, and the most frequent symptom was metrorrhagia. We did not use any type of anaesthesia in 89.5% of patients and we could access the uterine cavity in 99.4% of cases. The complication rate was very low though 12% of patients reported severe pain while performing the test. Although office hysteroscopy in outpatients is fully established and is usually well tolerated, there is a group of patients who could benefit from analgesic treatment prior to the test, to improve their tolerance.
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Affiliation(s)
- P Carabias
- Department of Obstetrics and Gynecology, Mataró Hospital , Barcelona
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Craciunas L, Sajid MS, Howell R. Carbon dioxide versus normal saline as distension medium for diagnostic hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2013; 100:1709-14.e1-4. [DOI: 10.1016/j.fertnstert.2013.07.2003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 11/16/2022]
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The use of different size-hysteroscope in office hysteroscopy: our experience. Arch Gynecol Obstet 2013; 288:1355-9. [DOI: 10.1007/s00404-013-2932-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
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Fernández-Parra J, Rodríguez-Oliver A, González-Paredes A. Histeroscopia en consulta: análisis de 5.000 pacientes. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2010.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Hysterectomy has traditionally been the definitive surgical approach for heavy menstrual bleeding. However, the more modern concept of 'save the uterus' has led to new surgical approaches for the treatment of heavy menstrual bleeding, based on second-generation endometrial destruction (ablation/resection) techniques, including microwave endometrial ablation, thermal balloon endometrial ablation, radiofrequency electrosurgery, hydrothermal ablation and cryoablation. As pregnancy following endometrial ablation is still possible, we proposed to combine endometrial ablation and sterilization with Essure(®) micro-inserts in women with confirmed menometrorrhagia and the desire, or medical need, for permanent tubal sterilization. Although large diameter resectoscopy provides excellent results in the surgical treatment of myomas, the technique requires dilation of the cervical canal (difficult in nulliparous or menopausal patients), and requires general or epidural anaesthesia and, therefore, must be performed in an operating theatre. A major advance in terms of hysteroscopic procedures is the 'see and treat' approach (i.e. when performing an initial diagnostic hysteroscopy, it is now possible to treat the pathology concurrently). Newer hysteroscopic techniques, often not requiring anaesthesia or analgesia, include OPPIuM (Office Preparation of Partially Intramural Myomas) and use of a mini-resectoscope, allowing office diagnostic-operative hysteroscopic procedures.
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Affiliation(s)
- Hervé Fernandez
- Department of Gynecology and Obstetrics, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
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8
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Cooper NA, Smith P, Khan KS, Clark TJ. A systematic review of the effect of the distension medium on pain during outpatient hysteroscopy. Fertil Steril 2011; 95:264-71. [DOI: 10.1016/j.fertnstert.2010.04.080] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/19/2010] [Accepted: 04/30/2010] [Indexed: 11/24/2022]
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9
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Raimondo G, Raimondo D, D'Aniello G, Russo C, Ronga A, Gabbanini M, Filippeschi M, Petraglia F, Florio P. A randomized controlled study comparing carbon dioxide versus normal saline as distension media in diagnostic office hysteroscopy: is the distension with carbon dioxide a problem? Fertil Steril 2010; 94:2319-22. [DOI: 10.1016/j.fertnstert.2009.11.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 11/18/2009] [Accepted: 11/19/2009] [Indexed: 11/27/2022]
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Siristatidis C, Chrelias C, Salamalekis G, Kassanos D. Office hysteroscopy: current trends and potential applications: a critical review. Arch Gynecol Obstet 2010; 282:383-8. [PMID: 20349076 DOI: 10.1007/s00404-010-1437-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 03/09/2010] [Indexed: 11/27/2022]
Abstract
Office hysteroscopy is an excellent method of identifying and treating intracavitary uterine lesions. It has become easy to learn and perform; as an aid of modern technological applications, it is safe, accurate, provides immediate results under direct visualisation, and offers the additional benefit of histological confirmation and the discomfort of patients is minimal. We applied an extended literature search to explore the special features and details of the technique itself, as it evolved since it first appeared 30 years back. Our initial goal was to examine potential changes/improvements of the modality, in terms of the instrumentation used and the technique itself, the indications of use, its incorporation in daily practice, and patients' and clinicians' acceptability.
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Di Spiezio Sardo A, Mazzon I, Bramante S, Bettocchi S, Bifulco G, Guida M, Nappi C. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Reprod Update 2007; 14:101-19. [DOI: 10.1093/humupd/dmm041] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: A cohort study. J Minim Invasive Gynecol 2007; 14:729-35. [DOI: 10.1016/j.jmig.2007.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 05/14/2007] [Accepted: 05/18/2007] [Indexed: 11/23/2022]
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13
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Muzii L, Bellati F, Pernice M, Manci N, Angioli R, Panici PB. Resectoscopic versus bipolar electrode excision of endometrial polyps: a randomized study. Fertil Steril 2007; 87:909-17. [DOI: 10.1016/j.fertnstert.2006.08.113] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 08/14/2006] [Accepted: 08/14/2006] [Indexed: 10/23/2022]
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Nichols M, Carter JF, Fylstra DL, Childers M. A comparative study of hysteroscopic sterilization performed in-office versus a hospital operating room. J Minim Invasive Gynecol 2006; 13:447-50. [PMID: 16962530 DOI: 10.1016/j.jmig.2006.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 05/21/2006] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To compare hysteroscopic female sterilization procedures performed in-office versus a hospital operating room (OR) among newly trained physicians. DESIGN Multisite hospital operating rooms and physician offices. PATIENTS Women desiring permanent hysteroscopic sterilization. INTERVENTION Hysteroscopic female sterilization with the Essure system. MEASUREMENTS AND MAIN RESULTS Procedure time (scope in/scope out time), device placement rates, and incidence of complications and adverse events were compared. There was no significant difference in scope time between the 2 settings. There was no significant difference in placement rates, although the placement rate was somewhat higher in-office (91% vs 88%). There were no complications among any of the procedures, and the incidence of minor adverse events was extremely low in both settings (OR=2%, in-office=1%). CONCLUSION There is no clear advantage to performing hysteroscopic sterilization in a hospital OR. Hysteroscopic sterilization can be performed safely and efficiently in an office setting.
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Affiliation(s)
- Mark Nichols
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
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Garbin O, Kutnahorsky R, Göllner JL, Vayssiere C. Vaginoscopic versus conventional approaches to outpatient diagnostic hysteroscopy: a two-centre randomized prospective study. Hum Reprod 2006; 21:2996-3000. [PMID: 16845121 DOI: 10.1093/humrep/del276] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To compare the tolerability and feasibility of the transvaginal and standard approaches in outpatient diagnostic hysteroscopy. METHODS This randomized prospective trial was carried out in two centres to compare the transvaginal (n = 200) and conventional (n = 200) approaches during outpatient hysteroscopy. Patients were randomized by a computer-generated list. The main outcome measure was pain during the examination, measured on a visual analogue scale (VAS) graded from 0 to 10 (0 = lowest, 10 = highest). Secondary criteria were ease of instrument passage through the cervix, investigation quality and its duration. For data analysis, we used the chi-squared test or Fischer's exact test for qualitative variables and the Mann-Whitney U-test for quantitative variables. RESULTS Median VAS was rated at 0.5 for the vaginoscopic and 2 for the standard (P < 0.0001) approaches. The approaches did not differ significantly in investigation quality, procedure duration or ease of cervical passage (although the latter was more often easy transvaginally). CONCLUSIONS The transvaginal approach is better tolerated than the conventional technique in outpatient diagnostic hysteroscopy.
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Affiliation(s)
- O Garbin
- Service de Gynécologie, SIHCUS-CMCO, Schiltigheim, France.
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Preutthipan S, Herabutya Y. Hysteroscopic polypectomy in 240 premenopausal and postmenopausal women. Fertil Steril 2005; 83:705-9. [PMID: 15749501 DOI: 10.1016/j.fertnstert.2004.08.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 08/23/2004] [Accepted: 08/23/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To ascertain the therapeutic efficacy and safety of hysteroscopic polypectomy in 240 premenopausal and postmenopausal patients. DESIGN Retrospective study. SETTING Tertiary university hospital. PATIENT(S) Two hundred forty patients with intrauterine endometrial polyps, who mostly suffered from abnormal uterine bleeding and infertility. INTERVENTION(S) Hysteroscopic polypectomy using various instruments including microscissors, grasping forceps, or electrosurgery either with a monopolar probe or a resectoscope. MAIN OUTCOME MEASURE(S) Operating time, amount of glycine absorption, complications, resumption of normal menstruation, cumulative pregnancy rate, and recurrent rate of polyps after hysteroscopic surgery. RESULT(S) Resectoscopic polypectomy needed more operating time, had more glycine absorption and complications, but less recurrence than other hysteroscopic techniques. The resectoscope had a 0% recurrence rate and that grasping forceps had a 15% recurrence rate. A total of 21 (8.7%) complications occurred, but no major complications were noted. After long-term follow-up of 9 years and 2 months, those with abnormal uterine bleeding resumed normal menstruation in 93.1% and those with infertility had a cumulative pregnancy rate of 42.3%. There was no statistical difference in reproductive outcome between patients having polyps < or = 2.5 cm and >2.5 cm. CONCLUSION(S) We found hysteroscopic polypectomy to be effective, safe, minimally invasive procedure with low rate and mild complications. Restoration of reproductive ability did not depend on the size of the removed lesion. Resectoscopic surgery is more preferable to prevent recurrence of polyps.
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Affiliation(s)
- Sangchai Preutthipan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Paschopoulos M, Kaponis A, Makrydimas G, Zikopoulos K, Alamanos Y, O'Donovan P, Paraskevaidis E. Selecting distending medium for out-patient hysteroscopy. Does it really matter? Hum Reprod 2004; 19:2619-25. [PMID: 15459167 DOI: 10.1093/humrep/deh464] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this prospective randomized study was to evaluate the role of carbon dioxide (CO2) and normal saline for diagnostic accuracy in out-patient hysteroscopy. METHODS Women admitted to our Department in order to undergo total abdominal hysterectomy also underwent diagnostic hysteroscopy, 12-24 h prior to surgery. The selection of distending medium was made after randomization. Two groups of patients were formed, group A (CO2; n=39) and group B (normal saline; n=35). More than half of the women in the study population were post-menopausal. Post-hysteroscopy, all women were asked to rank any symptom that they felt during the procedure on a 4-point scale (0=none; 1=mild; 2=severe; 3=inability to perform hysteroscopy). The hysteroscopic diagnosis was compared with the macroscopic findings and the histological examination of the surgical specimen after hysterectomy. RESULTS The percentage who completed hysteroscopy was 89.74% within group A and 97.14% within group B. Most patients of both groups felt some pain of mild intensity. The diagnostic accuracy of hysteroscopy was similar for both media when major pathology [large polyps (group A 91.7%; group B 92.7%), myomas (group A 81.25%; group B 92.7%) and/or hyperplasia (group A 87.5%; group B 90.2%)] of the endometrial cavity was detected. In contrast, in cases of minor pathology (small polyps, mucosal elevations, crypts, hypervascularization), hysteroscopy with saline presented with significantly higher diagnostic accuracy (85.4%) compared with hysteroscopy with CO2 (64.6%). CONCLUSIONS In out-patient hysteroscopy, CO2 and normal saline were comparable with regard to patient discomfort and for the detection of major pathology of the endometrial cavity. Normal saline seems to be the most appropriate medium for the detection of minor pathology of the endometrial cavity.
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Affiliation(s)
- M Paschopoulos
- Department of Obstetrics and Gynecology, Ioannina University School of Medicine, 45500 Ioannina, Greece
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Agostini A, Bretelle F, Ronda I, Roger V, Cravello L, Blanc B. Risk of Vasovagal Syndrome During Outpatient Hysteroscopy. ACTA ACUST UNITED AC 2004; 11:245-7. [PMID: 15200783 DOI: 10.1016/s1074-3804(05)60207-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To evaluate influence of hysteroscope type and media used during outpatient hysteroscopy on vasovagal syndrome risk. STUDY DESIGN Prospective observational study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS Two thousand seventy-nine women undergoing outpatient hysteroscopy without analgesia. INTERVENTION Office hysteroscopy with a flexible or rigid hysteroscope and normal saline or CO(2). MEASUREMENTS AND MAIN RESULTS Fifteen cases of vasovagal syndrome were reported. The rate of vasovagal syndrome was higher with use of a rigid hysteroscope (12/647 [1.85%]) vs. a flexible hysteroscope (3/1432 [0.21%]), p =.00013; p =.009 after adjustment for medium used; and with the use of CO2 (10/426 [2.34%]) vs. saline solution (5/1653 [0.30%]), p <.0001; p =.014 after adjustment for hysteroscope type. CONCLUSION Risk of vasovagal syndrome is higher with the use of a rigid hysteroscope and CO2, regardless of the indication for hysteroscopy or the parity and menopausal status of the patient.
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Affiliation(s)
- Aubert Agostini
- Department of Obstetrics and Gynecology B, La Conception Hospital, Marseilles, France
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Cicinelli E, Parisi C, Galantino P, Pinto V, Barba B, Schonauer S. Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases. Fertil Steril 2003; 80:199-202. [PMID: 12849824 DOI: 10.1016/s0015-0282(03)00546-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the reliability, feasibility, and safety of lens-based minihysteroscopy. DESIGN Retrospective comparative study. SETTING Academic research environment. PATIENT(S) Women with different indications for hysteroscopy. INTERVENTION(S) Six thousand seventeen outpatient diagnostic hysteroscopies with a minihysteroscope (2.7-mm outer diameter [OD] telescope with 3.5-mm OD single-flow diagnostic sheath) and 4,204 with traditional hysteroscope (4-mm OD telescope with 5-mm OD single-flow diagnostic sheath). All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus. MAIN OUTCOME MEASURE(S) Rate of successful introduction of the hysteroscope, rate of satisfactory examinations, pain intensity experienced using an arbitrary pain scale (0 = no pain; 1 = low pain; 2 = moderate pain; 3 = severe pain), and number of side effects and complications. RESULT(S) In the minihysteroscopy, group rates of successful introduction and satisfactory examinations were significantly higher than in the traditional hysteroscope group (99.52% vs.72.53% and 98.53% vs. 92.33%, respectively), while pain and vagal reactions were significantly lower (0.10 +/- 0.34 vs.1.09 +/- 0.53 and 2.25% vs.17.12%, respectively). CONCLUSION(S) Hysteroscopy with lens-based minihysteroscopes was easier, less painful, more reliable, and safer than with 5-mm hysteroscopes. Minihysteroscopy with a vaginoscopic approach is a very well tolerated, effective, and safe outpatient procedure.
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Affiliation(s)
- Ettore Cicinelli
- First Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
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Beukenholdt R, Guerrero K. An audit of a specialist registrar-run outpatient diagnostic hysteroscopy service in a district general hospital. J OBSTET GYNAECOL 2003; 23:294-6. [PMID: 12850865 DOI: 10.1080/01443610310000100132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We aimed to audit a specialist registrar-run outpatient hysteroscopy service. This was a retrospective audit conducted in small district general hospital. All patients attending the outpatient hysteroscopy clinic during a 3-month period were studied. The patients' medical notes were used to collect data. Forty-five women attended the outpatient hysteroscopy clinic during the 3-month time period. The hysteroscopy was performed satisfactorily in 91.1% of cases. Pathology was found in 39% of cases. In 34.1% of cases an endometrial polyp was found and in 7.3% of cases a submucous fibroid was seen. An endometrial biopsy was performed in 65.8% of cases and no malignancies were found. The inpatient hysteroscopy rate was higher than expected due to the high incidence of polyps, not because women could not be satisfactorily hysteroscoped in the clinic. A registrar-run outpatient hysteroscopy clinic is a viable and useful tool. Audit standards can be set and protocols developed.
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Affiliation(s)
- R Beukenholdt
- Department of Obstetrics and Gynaecology, Princess of Wales Hospital, Bridgend, UK.
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Brusco GF, Arena S, Angelini A. Use of carbon dioxide versus normal saline for diagnostic hysteroscopy. Fertil Steril 2003; 79:993-7. [PMID: 12749443 DOI: 10.1016/s0015-0282(02)04947-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare CO2 and normal saline as distention medium in diagnostic hysteroscopy. DESIGN Prospective randomized study. SETTING University-based artificial insemination and sterility center in Italy. PATIENT(S) Seventy-four women who underwent hysteroscopy. INTERVENTION(S) Hysteroscopy was performed with CO2 or normal saline. MAIN OUTCOME MEASURE(S) Quality of intrauterine images, cervical dilatation, local anesthesia, and duration of the test. In addition, each patient evaluated pain during and after the examination, irritation of the phrenic plexus, analgesic use, and side effects. RESULT(S) The quality of the hysteroscopic image was statistically similar for both media. Dilatation of the cervical canal and use of local anesthesia was more often necessary in the CO2 group. The procedure time was 5.96 +/- 1.55 minutes in the CO2 group and 3.12 +/- 0.96 in the normal saline group. The CO2 group reported pain more frequently during and after the examination, shoulder pain, greater analgesic use, and more side effects. CONCLUSION(S) For hysteroscopy, normal saline is technically equal to CO2 in terms of image quality and ease of use but offers more advantages. Hysteroscopy with normal saline is more acceptable to patients, quicker to perform, and entails fewer additional procedures.
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Affiliation(s)
- Gian Francesco Brusco
- Centro Sterilità e Fecondazione Assistita, Dipartimento Materno-Infantile, Università degli Studi di Perugia-Azienda Ospedaliera di Perugia, Perugia, Italy.
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Shushan A, Revel A, Laufer N, Rojansky N. Hysteroscopic treatment of intrauterine lesions in premenopausal and postmenopausal women. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:209-13. [PMID: 11960050 DOI: 10.1016/s1074-3804(05)60134-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To compare the safety and efficacy of hysteroscopic surgery in the management of intrauterine lesions in premenopausal and postmenopausal women and, in particular, to investigate whether glycine absorption is different between these populations. DESIGN Comparative study (Canadian Task Force classification II-2). SETTING Tertiary care university hospital. PATIENTS Thirty postmenopausal and 78 premenopausal women with intrauterine polyps or myomas. INTERVENTION Hysteroscopic myomectomy or polypectomy. MEASUREMENTS AND MAIN RESULTS One hundred eight procedures were completed successfully by hysteroscopy; in two cases myomectomy was completed in a second operation for a deeply embedded myoma. No major complications occurred in either group. Median operating time, mean glycine absorption, and median postoperative hospital stay were not significantly different between groups. During mean follow-up of 15 months (range 1-39 mo), four women underwent hysterectomy (1 for endometrial cancer, 1 for complex hyperplasia with atypia, 2 for pelvic pain and menorrhagia). CONCLUSION Hysteroscopic surgery is an effective and safe therapeutic option for intrauterine lesions regardless of a woman's menopausal status.
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Affiliation(s)
- Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah University Hospital, P.O. Box 12000, Jerusalem, Israel
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