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D'Urso V, Gulino FA, Incognito GG, Cimino M, Dilisi V, Di Stefano A, Gulisano M, Cannone F, Capriglione S, Palumbo M. Hysteroscopic Findings and Operative Treatment: All at Once? J Clin Med 2023; 12:4232. [PMID: 37445266 DOI: 10.3390/jcm12134232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called "office hysteroscopy" or "see-and-treat hysteroscopy", whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal.
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Affiliation(s)
- Valentina D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Monia Cimino
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Valentina Dilisi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Alessandra Di Stefano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Marianna Gulisano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Francesco Cannone
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Ospedale "Santa Maria Alla Gruccia" Piazza del Volontariato 2, 52025 Montevarchi, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
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Outpatient Hysteroscopic Polypectomy-A Retrospective Study Comparing Rigid and Semirigid Office Hysteroscopes. Diagnostics (Basel) 2023; 13:diagnostics13050988. [PMID: 36900132 PMCID: PMC10000849 DOI: 10.3390/diagnostics13050988] [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: 10/31/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients' pain perception during an operative hysteroscopic endometrial polypectomy in an outpatient setting with two different hysteroscopes (rigid and semirigid) and to identify some clinical and intraoperative characteristics that are related to worsening pain during the procedure. We included women that underwent, at the same time as an diagnostic hysteroscopy, the complete removal of an endometrial polyp (using the see-and-treat strategy) without any kind of analgesia. A total of 166 patients were enrolled, of which 102 patients underwent a polypectomy with a semirigid hysteroscope and 64 patients underwent the procedure with a rigid hysteroscope. No differences were found during the diagnostic step; on the contrary, after the operative procedure, a statistically significant greater degree of pain was reported when the semirigid hysteroscope was used. Cervical stenosis and menopausal status were risk factors for pain both in the diagnostic step and in the operative one. Our results confirm that operative hysteroscopic endometrial polypectomy in an outpatient setting is an effective, safe, and well-tolerated procedure and indicate that it might be better tolerated if a rigid rather than semirigid instrument is used.
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Kanagasabai PS, Filoche S, Grainger R, Henry C, Hay-Smith J. Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review. Int J Gynaecol Obstet 2023; 160:38-48. [PMID: 35429335 PMCID: PMC10084285 DOI: 10.1002/ijgo.14224] [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: 12/22/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Women with abnormal uterine bleeding (AUB) experience barriers to accessing healthcare services. OBJECTIVES To identify and describe the evidence on interventions to improve healthcare access of women with AUB. SEARCH STRATEGY A systematic search of databases including Medline, CINAHL, EMBASE, Scopus, and Cochrane register for clinical trials on February 26, 2021. SELECTION CRITERIA Studies including women with AUB and investigating an intervention to improve access at the levels of individual patient, community, organization, health system, or medical education. DATA COLLECTION AND ANALYSIS Data extraction and descriptive analysis of the country, study design, settings, participant characteristics, intervention, outcome measures, and key findings. MAIN RESULTS We identified 20 studies and most interventions (13 studies) targeted organizational changes. Creating a multidisciplinary team, bringing services together and developing a care pathway improved the availability of services. Management of AUB in an outpatient setting improved the affordability. The use of decision aids improved patient engagement in consultations. There is a lack of interventions at an individual or community level targeting health literacy, health beliefs, social acceptability, and opportunity to reach and pay for services. CONCLUSIONS Community-based culturally-adapted interventions focusing on access to women with different socio-economic and cultural backgrounds should be investigated.
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Affiliation(s)
| | - Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Claire Henry
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Institute, University of Otago Wellington, Wellington, New Zealand
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van Gemert J, Herman M, Beelen P, Geomini P, Bongers M. Endometrial polypectomy using tissue removal device or electrosurgical snare: a randomised controlled trial. Facts Views Vis Obgyn 2022; 14:235-243. [DOI: 10.52054/fvvo.14.3.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hysteroscopic transcervical resection of endometrial polyps is a widely used method and is increasingly performed in office or outpatient care. To ensure patient comfort is key, smaller instruments are preferred while also achieving a complete resection of the pathology.
Objectives: To evaluate the effectiveness of the electrosurgical polyp snare (DPS) in comparison with a tissue removal device (TRD).
Materials and Methods: This was a randomised controlled non-inferiority trial which included 66 women with symptomatic endometrial polyps who had been referred to the gynaecological outpatient clinic at the Máxima Medical Centre, Veldhoven, the Netherlands. The patients were randomly allocated by using sealed envelopes to treatment with either the DPS (Duckbill®, Cook) or the TRD (Truclear™, Medtronic). Clinicians and patients were not blinded to the treatment performed. An independent observer blindly assessed the results.
Main outcome measures: The primary outcome was the complete removal of the endometrial polyp. Secondary outcomes were woman acceptability and pain during the procedure, operating time, peri-operative and immediate postoperative complications.
Results: 57% of the polyps in the DPS group and 95% in the TRD group were completely removed (risk difference -0.39; 95% CI: -0.60 to -0.15). Average operating time was longer with DPS compared to the TRD (11.7 min. vs. 6.8 min., p = 0.018). The number of insertions of the hysteroscope was higher with the DPS compared to the TRD (3.9 vs. 1.7, p <0.001). One serious adverse event, a uterine perforation, occurred in the DPS group.
Conclusion: The TRD was superior to the DPS in completeness of polyp removal.
What is new? TRD has a higher rate of complete polyp resection, overall safety and higher patient satisfaction, this instrument should be considered as the preferred option in outpatient and office gynaecology.
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Munro MG, Kasiewicz JL, Desai VB. Office Versus Institutional Operative Hysteroscopy: An economic model. J Minim Invasive Gynecol 2021; 29:535-548. [PMID: 34933096 DOI: 10.1016/j.jmig.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Model and compare estimated health system costs and gynecologic practice revenues when hysteroscopic surgery is performed in the office or institutional setting, either an ambulatory surgical center (ASC) or a traditional operating room (OR) Design: Economic modeling exercise Setting, Patients and Interventions: Non-clinical Measurements and Main Results: An economic model was developed that included US reimbursement rates for the office and institutional settings as well as the inherent expenses required for office hysteroscopic surgery. For CPT Code 58558, hysteroscopic biopsy and/or polypectomy, total health system costs were estimated as follows: Office, $1,382.48; ASC, $1,655.31; OR $2,918.10. In the modeled office setting, costs for the same procedure were estimated from instrumentation and supply list prices obtained from vendors and staffing costs from national databases. Revenue and cost modeling were performed and compared both for one to ten monthly procedure volumes and by hysteroscopic systems, while other elements of the procedure were standardized, including technique, staffing, generic supplies, and the use of local anesthesia. Four vendors provided system price information; one purpose built, one electromechanical, and two traditional. The projected office-based, per-case net revenue with the purpose-built system was always greater than in the ASC or OR, and relatively independent of monthly procedure volume (1 per month $743.59; 10 per month $876.17). For the traditional and electromechanical systems, it took from 2 to 5 monthly procedures to realize a net revenue greater than $239.39. Using 3 sets of vendor matched instruments, at 10 cases per month, the per case net revenue for the electromechanical system was $514.00, and for the two traditional systems $564.02 and $693.72. CONCLUSION Performance of office-based hysteroscopic surgery is associated with reduced health system costs when compared to the institutional environment. The net revenue for the practice was dependent on both the volume of procedures performed and the hysteroscopic system and technique selected.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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La Marca A, Gaia G, Mignini Renzini M, Alboni C, Mastellari E. Hysteroscopic findings in chronic endometritis. Minerva Obstet Gynecol 2021; 73:790-805. [PMID: 34905882 DOI: 10.23736/s2724-606x.21.04970-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic endometritis (CE) is a subtle pathology. Despite being difficult to detect and probably underdiagnosed, it has great clinical relevance, representing as it does a reversible cause of infertility. Nowadays, histological examination with identification of endometrial stromal plasma cells is considered the gold standard for diagnosis. Diagnostic difficulties persist, however, as a result of the technical limitations of this method and the lack of standardized histological diagnostic criteria. Hysteroscopy has been proposed as an aid for CE diagnosis. The method works by detecting signs of inflammation (focal or diffuse hyperemia, stromal edema, presence of micropolyps and the typical strawberry aspect) on the endometrial surface. Yet, the jury is still out on how reliable this technique is. Hysteroscopy displays a high sensitivity (over 86% and up to 100%) and high negative predictive value (over 92% and up to 100%) in the diagnosis of CE, and it should probably be performed routinely in the assessment of patients with unexplained infertility, repeated implantation failure and repeated pregnancy loss; however, since values in the literature regarding specificity are conflicting, in cases of suspected CE, hysteroscopy may be combined with histological examination, which remains the gold standard to confirm CE. Considering that histopathological evaluation probably underdiagnoses CE, and that hysteroscopy tends to overdiagnose, further studies are needed to determine which technique (or combination of techniques) has greater value for patients.
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Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica Eugin Modena, Modena, Italy -
| | - Giorgia Gaia
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Mignini Renzini
- Clinica Eugin Modena, Modena, Italy
- Biogenesi Reproductive Medicine Center, Istituti Clinici Zucchi, Monza, Monza e Brianza, Italy
| | - Carlo Alboni
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Mastellari
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Carugno J, Grimbizis G, Franchini M, Alonso L, Bradley L, Campo R, Catena U, De Angelis C, Di Spiezio Sardo A, Farrugia M, Haimovich S, Isaacson K, Moawad N, Saridogan E, Clark TJ. International Consensus Statement for recommended terminology describing hysteroscopic procedures. Facts Views Vis Obgyn 2021; 13:287-294. [PMID: 34647447 PMCID: PMC9148713 DOI: 10.52054/fvvo.13.4.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Carugno J, Grimbizis G, Franchini M, Alonso L, Bradley L, Campo R, Catena U, Carlo DA, Attilio DSS, Martin F, Sergio H, Isaacson K, Moawad N, Saridogan E, Clark TJ. International Consensus Statement for recommended terminology describing hysteroscopic procedures. J Minim Invasive Gynecol 2021; 29:385-391. [PMID: 34648932 DOI: 10.1016/j.jmig.2021.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department. Minimally Invasive Gynecology Division. University of Miami. Miller School of Medicine. Miami, Florida, USA
| | - Grigoris Grimbizis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623, Thessaloniki, Greece
| | - Mario Franchini
- Demetra Infertility Center and Villa Cherubini Clinic, Firenze, Italy
| | - Luis Alonso
- Endoscopy Unit, Centro Gutenberg, Malaga, Spain
| | | | | | - Ursula Catena
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - De Angelis Carlo
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Di Spiezio Sardo Attilio
- Department of Public Health, School of Medicine, University of Naples, "Federico II" Naples, Italy
| | | | - Haimovich Sergio
- Hillel Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, Technion, Israel
| | - Keith Isaacson
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Nash Moawad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ertan Saridogan
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing Institute for Women's Health, University College Hospital, NWI 2BU London, UK
| | - T Justin Clark
- Consultant Gynaecologist and Honorary Professor of Gynaecology, Birmingham Women's and Children Hospital and University of Birmingham, Birmingham, B15 2TT, UK
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Vitale SG, Riemma G, Alonso Pacheco L, Carugno J, Haimovich S, Tesarik J, De Angelis MC, Di Spiezio Sardo A, De Franciscis P. Hysteroscopic endometrial biopsy: from indications to instrumentation and techniques. A call to action. MINIM INVASIV THER 2021; 30:251-262. [PMID: 34369246 DOI: 10.1080/13645706.2021.1960862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
During the last twenty years, the diagnostic approach to endometrial pathology has radically evolved. For over a century, intrauterine blind biopsy techniques were considered the gold standard procedure for the histopathological diagnosis of intrauterine diseases. The advent of hysteroscopy, which made it possible to directly visualize the uterine cavity, and the subsequent miniaturization of the instruments allowing its use in the office setting without anesthesia are considered game-changers. To date, it is feasible to retrieve a targeted eye specimen of endometrial tissue with little or no discomfort for the patient in the office setting. To pursue this aim, several technological upgrades have improved the diagnostic accuracy of hysteroscopic endometrial biopsy. In this paper we provide an up-to-date review of the latest evidence regarding indications, instrumentations, and techniques for hysteroscopic endometrial biopsy, to help the operator in providing an adequate endometrial sampling for histopathological analysis.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luis Alonso Pacheco
- Department of Obstetrics and Gynecology, Endoscopy Unit at Centro Gutenberg, Malaga, Spain
| | - Jose Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | | | | | | | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Pynnä K, Räsänen P, Roine RP, Vuorela P, Sintonen H. Where does the money go to? Cost analysis of gynecological patients with a benign condition. PLoS One 2021; 16:e0254124. [PMID: 34242306 PMCID: PMC8270439 DOI: 10.1371/journal.pone.0254124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The impact of benign gynecological conditions on life of women and on costs for the society is high. The purpose of this study is to gain knowledge and understanding of costs of the treatment of these disorders in order to be able to improve the clinical care processes, gain insight into feasible savings opportunities and to allocate funds wisely. METHODS The healthcare processes of 311 women attending university or community hospitals in the Helsinki and Uusimaa Hospital District between June 2012 and August 2013 due to a benign gynecological condition were followed up for two years and treatment costs analysed. RESULTS Total direct hospital costs averaged 689€ at six months and 2194€ at two years. The most expensive treatment was that of uterine fibroids in the short term and that of endometriosis and fibroids later on. Costs did not depend on hospital size. Surgical operations caused nearly half of hospital costs. Productivity loss caused biggest expenses outside of the hospital. LNG-IUD (levonorgestrel-releasing intrauterine device) accounted for the largest pharmaceutical costs for patients. Hospital treatment was associated with a reduced need for outpatient services during follow-up. CONCLUSIONS A majority of direct hospital costs arise over time. This stresses the need for prolonged healthcare management. To control costs, the need for repetitive doctors' appointments, monitoring tests, and ward treatments should be carefully evaluated. Procedures not needing an operation theatre (for example hysteroscopy for polypectomy), should be done ambulatorily.
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Affiliation(s)
- Kristiina Pynnä
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Räsänen
- Hospital District of Helsinki and Uusimaa, External Evaluation Unit, Helsinki, Finland
| | - Risto P. Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Piia Vuorela
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Helsinki, Finland
- City of Vantaa, Department of Health and Social Welfare, Vantaa, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Nanayakkara P, Xiao J, Aref-Adib M, Ades A. Increasing the adoption of ambulatory hysteroscopy in Australia - cost comparisons and patient satisfaction. J OBSTET GYNAECOL 2021; 42:509-513. [PMID: 34167426 DOI: 10.1080/01443615.2021.1916814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the findings of a prospective cohort study in a single tertiary hospital to review the patient experience and economic benefit of ambulatory hysteroscopy (AH). Data were collected between May 2017 and February 2020. Patient satisfaction was measured with qualitative survey. Hospital level financial data were obtained over two financial years (2017/18 and 2018/19) to identify seasonal variation. The primary outcome was patient satisfaction and the secondary outcome was cost of AH compared to hysteroscopy under GA. Three hundred and twenty-nine patients underwent AH. Two hundred and ninety-eight responses (91%) were collected. Ninety-five percent of procedures were successful. Median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it. The average hospital cost for AH was $259 compared with $3098 for hysteroscopy under GA. These findings support AH as a safe, well-tolerated and economically viable alternative to hysteroscopy under GA.Impact StatementWhat is already known on this subject? Hysteroscopy is traditionally performed in an operating theatre under general anaesthesia (GA). Technological advancements allow for the procedure to be performed in an outpatient setting. Despite advantages of ambulatory hysteroscopy (AH), GA hysteroscopy is still the predominant intervention in Australia.What the results of this study add? Patient satisfaction in AH was assessed. The median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it.What the implications are of these findings for clinical practice and/or further research? AH is a well-tolerated alternative to hysteroscopy under GA with significant cost benefits to the hospital and high patient satisfaction. Further research should focus on direct comparison of the two procedure approaches using randomised controlled trials.
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Affiliation(s)
- Pavitra Nanayakkara
- Department of Gynaecology, Epworth Hospital, Richmond, Australia.,Ambulatory Gynaecology Service, Royal Women's Hospital, Parkville, Australia
| | - Joyce Xiao
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Mehrnoosh Aref-Adib
- Department of Gynaecology, Epworth Hospital, Richmond, Australia.,Ambulatory Gynaecology Service, Royal Women's Hospital, Parkville, Australia
| | - Alex Ades
- Department of Gynaecology, Epworth Hospital, Richmond, Australia.,Ambulatory Gynaecology Service, Royal Women's Hospital, Parkville, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
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Law HY, Ng DYT, Chung CD. Use of music in reducing pain during outpatient hysteroscopy: Prospective randomized trial. J Obstet Gynaecol Res 2020; 47:904-912. [PMID: 33336450 DOI: 10.1111/jog.14608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/08/2020] [Accepted: 12/05/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effect of music in reducing pain during outpatient hysteroscopy under no anesthesia. METHODS We conducted a prospective randomized controlled trial From June 2019 to December 2019 in Pamela Youde Nethersole Eastern Hospital in Hong Kong. A total of 107 patients were randomized to music group (n = 54) or non-music group (n = 53). Music was played during outpatient hysteroscopy in the music group. Patients in the non-music group had the procedure done in the same setting without music. Primary outcome was the level of pain measured using the visual analog scale (VAS) score before and during the procedure. Secondary outcomes were vital parameters that reflect the level of pain including blood pressure and heart rate. RESULTS Patients in the music group experienced significantly less pain during outpatient hysteroscopy (VAS score 4.54 ± 2.89 vs 5.88 ± 2.90; P = 0.02). The anticipated pain level was similar in both groups (VAS score 5.59 ± 2.27 vs 6.11 ± 2.43; P = 0.27). There was no statistically significant difference between the two groups in all the vital parameters. CONCLUSION Listening to music during outpatient hysteroscopy under no anesthesia significantly reduces pain in a well-matched Chinese population. Music is easy to provide with low-cost equipment and manpower. We recommend the routine use of music during outpatient hysteroscopy to improve patient care.
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Affiliation(s)
- Ho Ying Law
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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Vitale SG, Parry JP, Carugno J, Cholkeri-Singh A, Della Corte L, Cianci S, Schiattarella A, Riemma G, De Franciscis P. Surgical and Reproductive Outcomes after Hysteroscopic Removal of Retained Products of Conception: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:204-217. [PMID: 33166659 DOI: 10.1016/j.jmig.2020.10.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact of hysteroscopy for retained products of conception (RPOC) removal on surgical and reproductive outcomes. DATA SOURCES Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, SciELO, EMBASE, and the Cochrane Central Register of Controlled Trials at the Cochrane Library) were searched from inception to March 2020. METHODS OF STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Medical Subject Headings terms and text words such as "retained products of conception," "placental remnants," "placenta," and "hysteroscopy" were used for the identification of relevant studies. We included observational and randomized studies that analyzed surgical and/or reproductive outcomes of women who underwent hysteroscopic removal of RPOC. The primary outcome was the complete resection rate after 1 procedure. TABULATION, INTEGRATION, AND RESULTS Twenty out of 245 studies were applicable, with data provided for 2112 women. The pooled complete resection rate was 91% (95% confidence interval [CI], 0.83-0.96). The incomplete resection rate evaluated was 7% (95% CI, 0.03-0.14), with a complication rate of 2% (95% CI, 0.00-0.04). Out of 1478 procedures, only 12 cases (0.8%) of postsurgical intrauterine adhesions were reported. Regarding post-therapy fecundity, women attempting postoperative conception had a clinical pregnancy rate of 87% (95% CI, 0.75-0.95), with a live birth rate of 71% (95% CI, 0.60-0.81) and a pregnancy loss rate of 9% (95% CI, 0.06-0.12). CONCLUSION Hysteroscopy has a high rate of completely removing RPOC in a single surgical step, with low complication rates. Subsequent fecundity seems reassuring, with appropriate clinical pregnancy and live birth rates. However, standardization of approach and comparative trials of different hysteroscopic approaches are needed.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania (Dr. Vitale), Catania, Italy.
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, Mississippi; Department of Obstetrics and Gynecology, University of Mississippi Medical Center (Dr. John Preston Parry), Jackson, Mississippi
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, Miller School of Medicine, University of Miami (Dr. Jose Carugno's), Miami, FL, USA
| | - Aarathi Cholkeri-Singh
- Department of Minimally Invasive Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA (Dr. Aarathi Cholkeri-Singh's)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II (Dr. Luigi Della Corte's), Naples, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy (Drs. Stefano Cianci, Antonio Schiattarella, Gaetano Riemma, Pasquale De Franciscis)
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Bennett A, Thavorn K, Arendas K, Coyle D, Singh SS. Outpatient uterine assessment and treatment unit in patients with abnormal uterine bleeding: an economic modelling study. CMAJ Open 2020; 8:E810-E818. [PMID: 33293330 PMCID: PMC7743907 DOI: 10.9778/cmajo.20190170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most often in Canada, the evaluation and management of abnormal uterine bleeding occurs under general anesthesia in the operating room. We aimed to assess the potential cost-effectiveness of an outpatient uterine assessment and treatment unit (UATU) compared with the current standard of care when diagnosing and treating abnormal uterine bleeding in women. METHODS We performed a cost-effectiveness analysis and developed a probabilistic decision tree model to simulate the total costs and outcomes of women receiving outpatient UATU or usual care over a 1-year time horizon (Apr. 1, 2014, to Mar. 31, 2017) at a tertiary care hospital in Ontario, Canada. Probabilities, resource use and time to diagnosis and treatment were obtained from a retrospective chart review of 200 randomly selected women who presented with abnormal uterine bleeding. Results were expressed as overall cost and time savings per patient. Costs are reported in 2018 Canadian dollars. RESULTS Compared with usual care, care in the UATU was associated with a decrease in overall cost ($1332, 95% confidence interval [CI] -$1742 to -$1008) and a decrease in overall time to treatment (-75, 95% CI -89 to -63, d). The point at which the UATU would no longer be cost saving is if the additional cost to operate and maintain the UATU is greater than $1600 per patient. INTERPRETATION From the perspective of Canada's health care system, an outpatient UATU is more cost effective than usual care and saves time. Future studies should focus on the relative efficacy of a UATU and the total budget required to operate and maintain a UATU.
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Affiliation(s)
- Alexandria Bennett
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
| | - Kednapa Thavorn
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont.
| | - Kristina Arendas
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
| | - Doug Coyle
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
| | - Sukhbir S Singh
- Clinical Epidemiology Program (Bennett, Thavorn), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Bennett, Thavorn, Arendas, Coyle, Singh), University of Ottawa; ICES uOttawa (Thavorn); Department of Obstetrics, Gynecology, and Newborn Care (Arendas, Singh), The Ottawa Hospital, Ottawa, Ont
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15
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The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol 2020; 135:e138-e148. [PMID: 32080054 DOI: 10.1097/aog.0000000000003712] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This Committee Opinion provides guidance on the current uses of hysteroscopy in the office and the operating room for the diagnosis and treatment of intrauterine pathology and the potential associated complications. General considerations for the use of diagnostic and operative hysteroscopy include managing distending media, timing for optimal visualization, and cervical preparations. In premenopausal women with regular menstrual cycles, the optimal timing for diagnostic hysteroscopy is during the follicular phase of the menstrual cycle after menstruation. Pregnancy should be reasonably excluded before performing hysteroscopy. There is insufficient evidence to recommend routine cervical ripening before diagnostic or operative hysteroscopy, but it may be considered for those patients at higher risk of cervical stenosis or increased pain with the surgical procedure. In randomized trials, patients reported a preference for office-based hysteroscopy, and office-based procedures are associated with higher patient satisfaction and faster recovery when compared with hospital-based operative hysteroscopy. Other potential benefits of office hysteroscopy include patient and physician convenience, avoidance of general anesthesia, less patient anxiety related to familiarity with the office setting, cost effectiveness, and more efficient use of the operating room for more complex hysteroscopic cases. Appropriate patient selection for office-based hysteroscopic procedures for women with known uterine pathology relies on thorough knowledge and understanding of the target pathology, size of the lesion, depth of penetration of the lesion, patient willingness to undergo an office-based procedure, physician skills and expertise, assessment of patient comorbidities, and availability of proper equipment and patient support. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL) agree that vaginoscopy may be considered when performing office hysteroscopy because studies have shown that it can significantly reduce procedural pain with similar efficacy. The office hysteroscopy analgesia regimens commonly described in the literature include a single agent or a combination of multiple agents, including a topical anesthetic, a nonsteroidal antiinflammatory drug, acetaminophen, a benzodiazepine, an opiate, and an intracervical or paracervical block, or both. Based on the currently available evidence, there is no clinically significant difference in safety or effectiveness of these regimens for pain management when compared to each other or placebo. Patient safety and comfort must be prioritized when performing office hysteroscopic procedures. Patients have the right to expect the same level of patient safety as is present in the hospital or ambulatory surgery setting.
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Cicinelli E, Vitagliano A, Kumar A, Lasmar RB, Bettocchi S, Haimovich S. Unified diagnostic criteria for chronic endometritis at fluid hysteroscopy: proposal and reliability evaluation through an international randomized-controlled observer study. Fertil Steril 2019; 112:162-173.e2. [PMID: 31104760 DOI: 10.1016/j.fertnstert.2019.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To develop a consensus on the diagnostic criteria for chronic endometritis (CE) at hysteroscopy (HSC), and to evaluate these proposed criteria in a randomized-controlled observer study. DESIGN Systematic review of studies evaluating the diagnostic accuracy of HSC in CE diagnosis; Delphi consensus on hysteroscopic diagnostic criteria for CE; randomized-controlled observer study to evaluate the reproducibility of the proposed diagnostic criteria. SETTING Not applicable. PARTICIPANT(S) Experts from different countries were involved in the systematic review and contributed to the Delphi consensus. Physicians from different countries were involved in the observer study. INTERVENTION(S) After reaching consensus on the diagnostic criteria, the Delphi poll created a questionnaire including 100 hysteroscopic pictures (50 from women with CE [domain 1] and 50 from women without CE [domain 2]), with a single question per picture (Answer_A: suggestive of CE; answer B: not suggestive of CE). A total of 200 physicians were invited to take part in the observer study. Before completing the questionnaire, physicians were randomized to receive a description of the diagnostic criteria (group A) or no such information (group B). MAIN OUTCOME MEASURE(S) The primary outcome was to compare the questionnaire scores for the two groups of observers. The secondary outcome was to assess the interobserver agreement in the diagnosis of CE in each group. RESULT(S) A total of 126 physicians completed the questionnaire (62 in group A and 64 in group B). Observers in group A obtained higher total scores compared with those in group B (P<.001). Specifically, group A showed higher mean score in domain 1 (P<.001), but not in domain 2 (P=.975). A substantial agreement was found among observers in group A (intraclass correlation coefficient [ICC] 0.78), whereas a fair agreement was found among observers in group B (ICC 0.40). CONCLUSION(S) This randomized-controlled observer study found a positive impact of our criteria on physicians' ability to recognize CE.
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Affiliation(s)
- Ettore Cicinelli
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health University of Padua, Padua, Italy.
| | - Alka Kumar
- Hysteroscopic Surgery Division, Women's Health Centre, Jaipur, India
| | | | - Stefano Bettocchi
- 2nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
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Luerti M, Vitagliano A, Di Spiezio Sardo A, Angioni S, Garuti G, De Angelis C. Effectiveness of Hysteroscopic Techniques for Endometrial Polyp Removal: The Italian Multicenter Trial. J Minim Invasive Gynecol 2018; 26:1169-1176. [PMID: 30528831 DOI: 10.1016/j.jmig.2018.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare the effectiveness and safety of different techniques of hysteroscopic polypectomy. DESIGN Multicenter, prospective observational trial (Canadian Task Force classification II-2). SETTING Nineteen Italian gynecologic departments (university-affiliated or public hospitals). PATIENTS Consecutive patients suffering from endometrial polyps (EPs). INTERVENTIONS Hysteroscopic polypectomy, as performed through different techniques. MEASUREMENTS AND MAIN RESULTS Included in the study were 1404 patients (with 1825 EPs). The setting was an ambulatory care unit in 40.38% of the cases (567 women), of whom 97.7% (554) did not require analgesia/anesthesia. In the remaining 59.62% of women (837 women), the procedures were performed in an operating room under mild sedation, local or general anesthesia. Minor complications occurred in 32 patients (2.27%), without significant differences between the techniques used (p = ns). Uterine perforation occurred in 14 cases, all performed in the operating room with some kind of anesthesia, only 1 with a vaginoscopic technique and the remaining during blind dilatation (odds ratio [OR], 19.98; 95% confidence interval [CI], 1.19-335.79; p = .04). An incomplete removal of EPs was documented in 39 patients. Logistic regression analysis showed that a higher risk of residual EPs was associated with the use of a fiber-based 3.5-mm hysteroscope (OR, 6.78; 95% CI, 2.97-15.52; p <.001), the outpatient setting (OR, 2.17; 95% CI, 1.14-4.14; p = .019), and EPs located at the tubal corner (OR, 1.98; 95% CI, 1.03-2.79; p = .039). No association between incomplete EP removal and EP size or number was recorded (p = ns), as well as with the other variables evaluated. CONCLUSION Outpatient polypectomy was associated with a minimal but significantly higher risk of residual EPs in comparison with inpatient polypectomy. Conversely, inpatient polypectomy was associated with a considerably higher risk of uterine perforation and penetration in comparison with office hysteroscopy. Because of lower intraoperative risks and higher cost-effectiveness, office hysteroscopy may be considered, whenever possible, as the gold standard technique for removing EPs.
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Affiliation(s)
- Massimo Luerti
- Department of Gynecology (Dr. Luerti), Istituto Clinico Città Studi, Milan, Italy
| | - Amerigo Vitagliano
- Department of Women's and Children's Health (Dr. Vitagliano), University of Padua, Padua, Italy
| | - Attilio Di Spiezio Sardo
- Department of Obstetrics and Gynecological (Dr. Di Spiezio Sardo), Urological Sciences and Reproductive Medicine, University "Federico II" of Naples, Naples, Italy.
| | - Stefano Angioni
- Department of Obstetrics and Gynecology (Dr. Angioni), University of Cagliari, Cagliari, Italy
| | - Giancarlo Garuti
- Department of Obstetrics and Gynecology (Dr. Garuti), Lodi Hospital, Lodi, Italy
| | - Carlo De Angelis
- Department of Women's Health and Territorial Medicine (Dr. De Angelis), University of Rome "La Sapienza", Rome, Italy
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Georgiou D, Tranoulis A, Jackson TL. Hysteroscopic tissue removal system (MyoSure) for the resection of polyps, sub-mucosal leiomyomas and retained products of conception in an out-patient setting: A single UK institution experience. Eur J Obstet Gynecol Reprod Biol 2018; 231:147-151. [DOI: 10.1016/j.ejogrb.2018.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022]
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Abstract
The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting.
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Affiliation(s)
- Shilpa Kolhe
- Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK
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20
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Salazar CA, Isaacson KB. Office Operative Hysteroscopy: An Update. J Minim Invasive Gynecol 2017; 25:199-208. [PMID: 28803811 DOI: 10.1016/j.jmig.2017.08.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 02/06/2023]
Abstract
Hysteroscopy is considered the gold standard for the evaluation of intracavitary pathology in both premenopausal and postmenopausal patients associated with abnormal uterine bleeding, as well as for the evaluation of infertile patients with suspected cavity abnormalities. Office-based operative hysteroscopy allows patients to resume activities immediately and successfully integrates clinical practice into a "see and treat" modality, avoiding the added risks of anesthesia and the inconvenience of the operating room. For 2017, the Centers for Medicare and Medicaid Services has provided a substantial increase in reimbursement for a select number of office-based hysteroscopic procedures. This review provides an update on the indications, equipment, and procedures for office hysteroscopy, as well as the management of complications that may arise within an office-based practice.
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Affiliation(s)
| | - Keith B Isaacson
- Newton Wellesley Hospital, Harvard Medical School, Newton, Massachusetts.
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21
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Santos-Paulo A, Solheiro MH. Re: An economic evaluation on outpatient versus inpatient polyp treatment for abnormal bleeding. BJOG 2017; 124:1449. [DOI: 10.1111/1471-0528.14675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 11/30/2022]
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Mouhayar Y, Yin O, Mumford SL, Segars JH. Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 213:107-115. [PMID: 28445799 DOI: 10.1016/j.ejogrb.2017.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/24/2022]
Abstract
The cost of fertility treatment is expensive and interventions that reduce cost can lead to greater efficiency and fewer embryos transferred. Endometrial polyps contribute to infertility and are frequently removed prior to infertility treatment. It is unclear whether polypectomy reduces fertility treatment cost and if so, the magnitude of cost reduction afforded by the procedure. The aim of this study was to determine whether performing office or operative hysteroscopic polypectomy prior to infertility treatment would be cost-effective. PubMed, Embase, and Cochrane libraries were used to identify publications reporting pregnancy rates after hysteroscopic polypectomy. Studies were required to have a polypectomy treatment group and control group of patients with polyps that were not resected. The charges of infertility treatments and polypectomy were obtained through infertility organizations and a private healthcare cost reporting website. These charges were applied to a decision tree model over the range of pregnancy rates observed in the representative studies to calculate an average cost per clinical or ongoing pregnancy. A sensitivity analysis was conducted to assess cost savings of polypectomy over a range of pregnancy rates and polypectomy costs. Pre-treatment office or operative hysteroscopic polypectomy ultimately saved €6658 ($7480) and €728 ($818), respectively, of the average cost per clinical pregnancy in women treated with four cycles of intrauterine insemination. Polypectomy prior to intrauterine insemination was cost-effective for clinical pregnancy rates greater than 30.2% for office polypectomy and 52.6% for operative polypectomy and for polypectomy price <€4414 ($4959). Office polypectomy or operative polypectomy saved €15,854 ($17,813) and €6644 ($7465), respectively, from the average cost per ongoing pregnancy for in vitro fertilization/intracytoplasmic sperm injection treated women and was cost-effective for ongoing pregnancy rates greater than 26.4% (office polypectomy) and 31.7% (operative polypectomy) and polypectomy price <€6376 ($7164). These findings suggested that office or operative hysteroscopic polypectomy was cost-effective when performed prior to both intrauterine insemination and in vitro fertilization over a range of plausible pregnancy rates and procedural costs.
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Affiliation(s)
- Youssef Mouhayar
- Department of Obstetrics and Gynecology, University of Miami-Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
| | - Ophelia Yin
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sunni L Mumford
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - James H Segars
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA.
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Endometrial Polyps and Abnormal Uterine Bleeding (AUB-P): What is the relationship, how are they diagnosed and how are they treated? Best Pract Res Clin Obstet Gynaecol 2017; 40:89-104. [DOI: 10.1016/j.bpobgyn.2016.09.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/23/2016] [Indexed: 12/11/2022]
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Mahomed K, McLean J, Ahmed M, Zolotarev B, Shaddock N. Intrauterine anaesthetic after hysteroscopy to reduce post-operative pain - A double blind randomised controlled trial. Aust N Z J Obstet Gynaecol 2016; 56:484-488. [DOI: 10.1111/ajo.12498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kassam Mahomed
- Department of Obstetrics and Gynaecology; Ipswich Hospital and University of Queensland; Ipswich Queensland Australia
| | - Jim McLean
- Department of Anaesthetics; Ipswich Hospital; Ipswich Queensland Australia
| | - Muhtashim Ahmed
- Department of Medical Services, Clinical Governance, Education and Research; Ipswich Hospital; Ipswich Queensland Australia
| | - Boris Zolotarev
- Department of Obstetrics and Gynaecology; Ipswich Hospital and University of Queensland; Ipswich Queensland Australia
| | - Natalie Shaddock
- Department of Obstetrics; Ipswich Hospital; Ipswich Queensland Australia
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