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Welykholowa K, Allaire C, Fisher S, Epp A, Lee CE. Safety and Efficiency Outcomes of Ambulatory Gynaecologic Procedures in Canadian Surgical Centres Adopting a Common Model. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102336. [PMID: 38159680 DOI: 10.1016/j.jogc.2023.102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The present study aims to compare the safety and efficiency outcomes of ambulatory gynaecologic procedures performed under conscious sedation and/or local anaesthetic at 2 Canadian institutions. METHODS A retrospective cohort study was completed over 1-year on patients presenting to the ambulatory care centres at 2 Canadian institutions that shared a common care model. Outcomes of interest were lead time (registration to discharge), procedural time, and intraoperative complications. Surgical data was derived from a retrospective chart review and outcomes were compared using the independent t test and one-way analysis of variance. RESULTS A total of 1495 and 1098 patients presented to the 2 sites. The average age of patients was 35.5 ± 12.3 years and 41.7 ± 10.2 years. The most commonly performed procedures were dilatation and curettages at the first centre and operative hysteroscopies at the second centre. Average lead times were similar: 170.3 ± 35.8 minutes and 171.6 ± 45.4 minutes (P = 0.45). There was a significant difference in mean procedural time being 9.8 ± 5.5 minutes and 17.0 ± 10.0 minutes (P < 0.001). The rate of minor intraoperative complications was 3.8% and 6.6% (P = 0.002); whereas the rate of major complications was 2.7% and 3.3% (P = 0.43). CONCLUSION In Canada, the majority of gynaecologic procedures are performed under general anesthesia. By comparing outcomes at 2 separate Canadian centres, we demonstrated the reproducibility of a common ambulatory model for minor gynaecologic procedures, supporting the implementation of similar care models across Canada.
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Affiliation(s)
- Kaylie Welykholowa
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Fisher
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Annette Epp
- Department of Obstetrics and Gynaecology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline E Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
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Khoiwal K, Zaman R, Bahurupi Y, Gaurav A, Chaturvedi J. Comparison of vaginoscopic hysteroscopy and traditional hysteroscopy: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 164:47-55. [PMID: 37306153 DOI: 10.1002/ijgo.14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Outpatient hysteroscopy is a safe, feasible, and optimum procedure for the diagnosis and management of intrauterine pathologies. OBJECTIVE To determine the best approach of outpatient hysteroscopy (vaginoscopic vs traditional) in terms of pain, duration of procedure, feasibility, safety, and acceptability. SEARCH STRATEGY PubMed, Embase, Google Scholar, and Scopus were searched from January 2000 to October 2021. No filters or restrictions were applied. SELECTION CRITERIA Randomized controlled trials comparing vaginoscopic hysteroscopy with traditional hysteroscopy in an outpatient setting. DATA COLLECTION AND ANALYSIS Two authors independently performed a comprehensive literature search and collected and extracted data. The summary effect estimate was determined using both fixed effects and random-effects models. RESULTS Seven studies with 2723 patients (vaginoscopic [n = 1378] and traditional hysteroscopy [n = 1345]) were included. Vaginoscopic hysteroscopy was associated with a significant reduction in intraprocedural pain (standardized mean difference, -0.05 [95% confidence interval (CI), -0.33 to -0.23], I2 = 0%), procedural time (standardized mean difference, -0.45 [95% CI, -0.76 to -0.14], I2 = 82%), and fewer side effects (relative risk, 0.37 [95% CI, 0.15-0.91], I2 = 0%). The procedure failure rate was similar in both approaches (relative risk, 0.97 [95% CI, 0.71-1.32], I2 = 43%). Complications were mostly documented with traditional hysteroscopy. CONCLUSION Vaginoscopic hysteroscopy reduces the pain and duration compared with traditional hysteroscopy.
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Affiliation(s)
- Kavita Khoiwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Rabia Zaman
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Amrita Gaurav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
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Sewell T, Fung Y, Al-Kufaishi A, Clifford K, Quinn S. Does virtual reality technology reduce pain and anxiety during outpatient hysteroscopy? A randomised controlled trial. BJOG 2023; 130:1466-1472. [PMID: 37218438 DOI: 10.1111/1471-0528.17550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of virtual reality technology in reducing pain and anxiety during outpatient hysteroscopy. DESIGN A prospective randomised controlled trial. SETTING A London University Teaching Hospital. POPULATION Women aged 18-70 years undergoing outpatient hysteroscopy procedures. METHODS An unblinded randomised controlled trial was performed between March and October 2022 comparing standard outpatient hysteroscopy care with standard care with the addition of a virtual reality headset playing a virtual reality immersive scenario as a distraction technique. MAIN OUTCOME MEASURES Pain and anxiety numeric rating scores (NRS) from 0 to 11. RESULTS Eighty-three participants were randomly allocated to the control (n = 42) and virtual reality groups (n = 41). The virtual reality group experienced significantly less anxiety during the procedure than the control group (mean NRS 3.29 versus 4.73, mean difference 1.50; 95% confidence interval [CI] 0.12-2.88; P = 0.03). There was no difference in reported average pain (mean NRS 3.73. versus 4.24, mean difference 0.51; 95% CI -1.76 to 0.64; p = 0.41) or maximum pain scores (mean NRS 5.32 versus 5.07, mean difference 0.25; 95% CI -1.05 to 1.55; P = 0.71). CONCLUSIONS The use of virtual reality technology as an adjunct to standard care can reduce patient-reported anxiety but not pain during outpatient hysteroscopy procedures. Continued improvements in the technology and the development of increasingly immersive environments may continue to increase the potential to improve the patient experience in this setting.
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Affiliation(s)
- Thomas Sewell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Yinka Fung
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Asmaa Al-Kufaishi
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Katy Clifford
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Stephen Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
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van Wessel S, Hamerlynck T, van Vliet H, Weyers S, Schoot B. Clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr ™ 5fr, for the resection of endometrial polyps in an office setting. Arch Gynecol Obstet 2023; 308:893-900. [PMID: 36920533 DOI: 10.1007/s00404-023-06995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE A first clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr™ 5fr, for office polypectomy without any anesthesia. METHODS Women with at least one small endometrial polyp were eligible. Hysteroscopic polypectomy was performed using the Resectr™ 5fr in an office setting, without any anesthesia. RESULTS One hundred and two hysteroscopic polypectomies were included in the analysis. The median installation time was 1.9 min (95% confidence interval (CI) 1.6-2.1). The median time to complete polyp removal was 1.2 min (95% CI 0.8-1.6). The median surgeon's safety, practical, and comfort scores on a 5-point Likert scale were high (5 (5-5), 5 (4-5), and 5 (4-5), respectively). Women's pain score was low (median 1 (0-3)), whereas the satisfaction rate was high (median 5 (5-5)), both on a 5-point Likert scale. There were two conversions (hysteroscopic scissors (n = 1), a new Resectr™ 5fr device (n = 1)). There was one incomplete procedure (tissue hardness). CONCLUSION Hysteroscopic removal of small polyps, using the [Formula: see text] 5fr in an office setting is feasible in terms of installation and resection time. Surgeon's practical, comfort, and safety scores are high, whereas women report low pain scores and high satisfaction rates. TRIAL REGISTRATION: Dutch Clinical Trial Registry (NTR 7119, NL6923): https://www.trialregister.nl/trial/6923 . Date of registration: 27/03/2018.
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Affiliation(s)
- Steffi van Wessel
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Tjalina Hamerlynck
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Huib van Vliet
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Benedictus Schoot
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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de Campos BF, Benetti-Pinto CL, Yela DA. Nurse support for pain and anxiety control in women undergoing diagnostic hysteroscopy: a randomized clinical trial. Menopause 2023; 30:927-932. [PMID: 37490654 DOI: 10.1097/gme.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the effectiveness of nurse support for controlling pain and anxiety in women undergoing diagnostic hysteroscopy. METHODS This randomized clinical trial included 192 women who underwent diagnostic hysteroscopy at an academic hospital. Women were divided into two groups: those who received nurse support (n = 95) as the intervention group and those who did not (n = 97) as the control group. RESULTS The mean age of women was 54.24 ± 13.91 years and 53.47 ± 13.24 years ( P = 0.670) in the intervention and control groups, respectively. There were no differences in clinical and sociodemographic variables between the groups. The mean pain score during examination was 6.62 ± 2.60 and 7.05 ± 2.30 ( P = 0.327) for the intervention and control groups, respectively. Most women in both groups were satisfied with the examination ( P = 0.777). There was a significant reduction in systolic blood pressure and heart rate during the examination in the intervention group ( P = 0.029 and P < 0.001, respectively) and an increase in anxiety scores in the control group ( P = 0.009). CONCLUSIONS There was no reduction in pain scores during hysteroscopy with nurse support. However, the control group showed an increase in anxiety scores after the hysteroscopy.
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Affiliation(s)
- Belisa Franco de Campos
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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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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Céspedes Martínez MA, Rovira Pampalona J, Degollada Bastos M, Izquierdo Argelich R, Bou Tapias J, Flores Laura MD, Brescó Torras P, Carugno Jose MD. Effectiveness and patient satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps. Facts Views Vis Obgyn 2022; 14:325-329. [PMID: 36724424 PMCID: PMC10364329 DOI: 10.52054/fvvo.14.4.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Endometrial polyps are a common cause of abnormal uterine bleeding. In-office hysteroscopic management is frequently performed to treat this frequently encountered pathology. Objectives To evaluate the long-term outcome and patients' satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps. Materials and Methods Retrospective longitudinal observational study of all hysteroscopic polypectomies performed at d'Igualada University Hospital (Barcelona, Spain) between May 2016 and December 2018. The medical records were reviewed, and a telephone interview was conducted with all the patients diagnosed with symptomatic endometrial polyps who underwent outpatient hysteroscopic polypectomy, with the purpose of evaluating the post-procedure symptomatology and satisfaction with the procedure. Main outcomes and results A total of 848 outpatient hysteroscopies were performed, 379 of which were polypectomies. Of those, 163 procedures were performed in symptomatic patients and were included in the final analysis. The most common symptom among premenopausal patients was abnormal uterine bleeding (84.85%) and in postmenopausal women, postmenopausal bleeding (95.3%). After the procedure, the symptoms resolved or decreased considerably in 66.7% of premenopausal and 93.7% of postmenopausal patients. Additionally, 87.1% of the patients were very satisfied with the procedure. Conclusion Office hysteroscopic polypectomy is an effective treatment for endometrial polyps with high patient satisfaction reported following the procedure.
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Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology. Obstet Gynecol 2022; 140:499-513. [PMID: 35926213 DOI: 10.1097/aog.0000000000004898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, müllerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.
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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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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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Cea García J, Jiménez Caraballo A, Ríos Vallejo MDM, Zapardiel I. Retrospective Cohort Study on the Symptomatic Recurrence Pattern after Hysteroscopic Polypectomy. Gynecol Minim Invasive Ther 2020; 9:209-214. [PMID: 33312864 PMCID: PMC7713653 DOI: 10.4103/gmit.gmit_102_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/06/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives The recurrence rate of benign endometrial polyps after a hysteroscopic polypectomy is low, between 0% and 15%. There are limited follow-up duration data on recurrence factors for benign polyps after hysteroscopic polypectomy, including recurrences with Versapoint® versus resectoscope. This study aims to estimate the rate of symptomatic recurrence following hysteroscopic polypectomy and to analyze the possible risk factors involved with Versapoint® versus resectoscope. Materials and Methods We designed a retrospective cohort study in a tertiary university hospital in Seville (Spain) which looked at the results of polypectomy with a 9-mm resectoscope on 42 women between 2008 and 2015 compared to 151 women using Versapoint® during 2014. Results The rate of first recurrence was 24.35%. There was a strong positive correlation between the recurrence and the follow-up duration (odds ratio [OR] = 2.58; 95% confidence interval [CI] = 1.68-5.04; P = 0.000), the polyps causing abnormal uterine bleeding (OR = 2.5; 95% CI: 1.1-3; P = 0.04), and a polyp size >15 mm (OR = 1.63; 95% CI = 1.3-3.1; P = 0.02). There were no statistical differences in polyps' recurrence among the types of hysteroscopic polypectomy (P > 0.05). Conclusion The main risk factors for recurrence were polyps causing abnormal uterine bleeding, size, and follow-up duration.
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Affiliation(s)
- Jorge Cea García
- Department of Gynecology, Clinical Management Unit of Obstetrics and Gynecology, Virgen Macarena University Hospital, Seville, Spain
| | - Antonio Jiménez Caraballo
- Department of Gynecology, Clinical Management Unit of Obstetrics and Gynecology, Virgen Macarena University Hospital, Seville, Spain
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Harrison R, Kuteesa W, Kapila A, Little M, Gandhi W, Ravindran D, van Reekum CM, Salomons TV. Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy. Br J Anaesth 2020; 125:e468-e470. [DOI: 10.1016/j.bja.2020.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
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Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding. Diagnostics (Basel) 2020; 10:diagnostics10110884. [PMID: 33142970 PMCID: PMC7692264 DOI: 10.3390/diagnostics10110884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022] Open
Abstract
Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system's resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.
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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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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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Selim MF, Abdou MMA, Mohamed ZE. Bilateral Ultrasound-Guided Erector-Spine Plane Block Versus General Anesthesia for Operative Hysteroscopic Polypectomy. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yen CF, Chou HH, Wu HM, Lee CL, Chang TC. Effectiveness and appropriateness in the application of office hysteroscopy. J Formos Med Assoc 2019; 118:1480-1487. [DOI: 10.1016/j.jfma.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/03/2018] [Accepted: 12/17/2018] [Indexed: 01/10/2023] Open
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Abstract
Hysteroscopy is performed to view and treat pathology within the uterine cavity and endocervix. Diagnostic hysteroscopy allows visualization of the endocervical canal, endometrial cavity, and fallopian tube ostia. Operative hysteroscopy incorporates the use of mechanical, electrosurgical, or laser instruments to treat intracavitary pathology and perform hysteroscopic sterilization procedures. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. A preoperative consultation allows the patient and physician to discuss the hysteroscopic procedure, weigh its inherent risks and benefits, review the patient's medical history for any comorbid conditions, and exclude pregnancy. Known pregnancy, genital tract infections, and active herpetic infection are contraindications to hysteroscopy. The most common perioperative complications associated with operative hysteroscopy are hemorrhage, uterine perforation, and cervical laceration. The procedure is minimally invasive and can be used with a high degree of safety.
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Bennett A, Lepage C, Thavorn K, Fergusson D, Murnaghan O, Coyle D, Singh SS. Effectiveness of Outpatient Versus Operating Room Hysteroscopy for the Diagnosis and Treatment of Uterine Conditions: A Systematic Review and Meta-Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:930-941. [DOI: 10.1016/j.jogc.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/21/2018] [Indexed: 10/27/2022]
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Guo T, Zhou H, Yang J, Wu P, Liu P, Liu Z, Li Z. Identifying the superior surgical procedure for endometrial polypectomy: A network meta-analysis. Int J Surg 2019; 62:28-33. [PMID: 30654144 DOI: 10.1016/j.ijsu.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify the superior surgical procedure for endometrial polypectomy based on network meta-analysis. METHOD Literature retrieval was conducted in globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating the clinical effects of respective surgical procedure for endometrial polypectomy. Surgical parametric data, including operative time, success rates and complications, were quantitatively pooled and estimated based on the Bayesian theorem. The values of surface under the cumulative ranking (SUCRA) probabilities regarding each parameter were calculated and ranked by various procedures. Node-splitting analysis was performed to test the inconsistency of the main results and publication bias was assessed by examining funnel-plot symmetry. RESULTS After a detailed review, 8 RCTs containing 5 different procedures were finally included for network meta-analysis. The results indicated that hysteroscopic morcellation possessed the highest possibility of revealing best clinical effects on operative time (SUCRA, 0.49), success rate (SUCRA, 0.90) and complications (SUCRA, 0.50). Moreover, node-splitting analysis and funnel-plot symmetries illustrated no inconsistency or obvious publication bias in the current study. CONCLUSIONS Current evidence demonstrated that hysteroscopic morcellation showed optimal potential superior clinical effects for endometrial polypectomy compared to other procedures. However, high-quality large sample trials are still expected, and new investigations on other relative procedures in this field should be included in the future.
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Affiliation(s)
- Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China
| | - Hui Zhou
- Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China
| | - Jian Yang
- School of Nursing, Huanggang Polytechnic College, Huanggang, 438002, PR China
| | - Ping Wu
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China
| | - Pengpeng Liu
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China
| | - Zhisu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China.
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China.
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Lee CE, Epp A. Safety and Efficiency in a Canadian Outpatient Gynaecological Surgical Centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:426-431. [DOI: 10.1016/j.jogc.2017.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
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Perioperative management of adult diabetic patients. Specific situations. Anaesth Crit Care Pain Med 2018; 37 Suppl 1:S31-S35. [PMID: 29555546 DOI: 10.1016/j.accpm.2018.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022]
Abstract
Ambulatory surgery can be carried out in diabetic patients. By using a strict organisational and technical approach, the risk of glycaemic imbalance is minimised, allowing the patients to return to their previous way of life more quickly. Taking into account the context of ambulatory surgery, with a same day discharge, the aims are to minimise the changes to antidiabetic treatment, to maintain adequate blood sugar control and to resume oral feeding as quickly as possible. The preoperative evaluation is the same as for a hospitalised patient and recent glycaemic control (HbA1c) is necessary. Perioperative management and the administration of treatment depend on the number of meals missed. The patient can return home after taking up usual feeding and treatment again. Hospitalisation is necessary if significant glycaemic imbalance occurs. In pregnancy, it is necessary to distinguish between known pre-existing diabetes (T1D or T2D) and gestational diabetes, defined as glucose intolerance discovered during pregnancy. During labour, blood sugar levels should be maintained between 0.8 and 1.4g/L (4.4-8.25mmol/L). Control of blood sugar levels is obtained by using a continuous administration of insulin using an electronic syringe (IVES) together with a glucose infusion. Post-partum, management depends on the type of diabetes: in T1D and T2D patients a basal-bolus scheme is restarted with decreased doses while in gestational diabetes insulin therapy is stopped after delivery. Antidiabetic treatment is again necessary if blood sugar levels remain>1.26g/L (7mmol/L).
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Roy KK, Lingampally A, Kansal Y, Bharti J, Kumar S, Vanamail P, Singhal S, Meena J. A Pilot Study Comparing Hysteroscopic Adhesiolysis by Conventional Resectoscope Versus Mini-resectoscope. Oman Med J 2017; 32:492-498. [PMID: 29218126 PMCID: PMC5702989 DOI: 10.5001/omj.2017.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/15/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To compare the feasibility and efficacy of the mini-resectoscope with the conventional resectoscope in terms of the operative, menstrual, and reproductive outcome in hysteroscopic adhesiolysis in infertile women. METHODS We conducted a parallel prospective randomized study at All India Institute of Medical Sciences, New Delhi. A total of 60 patients underwent hysteroscopic adhesiolysis using either conventional resectoscope (n = 30) or mini-resectoscope (n = 30). The primary outcome measures were pregnancy-related indicators. Secondary outcome measures were the operative parameters (cervical dilatation time, operation time, postoperative pain scores, fluid deficit, and preoperative and postoperative sodium levels), second-look hysteroscopy findings, and improvement in the menstrual pattern after surgery. RESULTS Cervical dilatation time and pain score 30 minutes after the procedure were significantly lower in the mini-resectoscope group. Out of the total 21 cases with hypomenorrhea, 12 cases (57.1%) started having normal menstrual flow postsurgery. All amenorrheic patients resumed menstruation after surgery. However, nine cases continued to have hypomenorrhea. Over long-term follow-up, 16 patients out of 60 had conceived (seven in the conventional resectoscope group and nine in the mini-resectoscope group). There were three ongoing pregnancies, three abortions, one ectopic pregnancy, and nine term pregnancies. The difference between the two groups was not statistically significant. CONCLUSIONS The use of mini-resectoscope for hysteroscopic adhesiolysis is associated with reduced operative morbidity. Use of the mini-resectoscope is an effective and safe alternative to the conventional system.
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Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Lingampally
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Yamini Kansal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Haggag H, Hassan A, Wahba A, Joukhadar R. A randomized double-blind controlled trial of different filling pressures in operative outpatient hysteroscopy. Int J Gynaecol Obstet 2017; 139:55-60. [DOI: 10.1002/ijgo.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/16/2017] [Accepted: 06/22/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Hisham Haggag
- Department of Obstetrics and Gynaecology; Faculty of Medicine; Cairo University; Cairo Egypt
- Department of Obstetrics and Gynaecology; University of Würzburg; Würzburg Germany
| | - AbdelGany Hassan
- Department of Obstetrics and Gynaecology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - Amr Wahba
- Department of Obstetrics and Gynaecology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - Ralf Joukhadar
- Department of Obstetrics and Gynaecology; University of Würzburg; Würzburg Germany
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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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Ma T, Readman E, Hicks L, Porter J, Cameron M, Ellett L, Mcilwaine K, Manwaring J, Maher P. Is outpatient hysteroscopy the new gold standard? Results from an 11 year prospective observational study. Aust N Z J Obstet Gynaecol 2016; 57:74-80. [PMID: 27861704 DOI: 10.1111/ajo.12560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Australia, gynaecologists continue to investigate women with abnormal bleeding and suspected intrauterine pathology with inpatient hysteroscopy despite some evidence in the literature that that there is no difference in safety and outcome when compared to an outpatient procedure. AIMS This prospective study assessed the safety, effectiveness and acceptability of outpatient hysteroscopy over 11 years at a tertiary hospital in Australia. Resource savings were then calculated. MATERIALS AND METHODS A prospective database was analysed from March 2003 to January 2014 (130 months, 990 women). RESULTS Successful hysteroscopic access was obtained in 94% of cases. Twenty-six percent of patients required a second procedure, including 132 for endometrial polyps and 33 for submucosal fibroids that were not able to be treated in the outpatient setting. On questioning, 88% of women would be happy to have the procedure again. Factors affecting success were pre-procedure pain, menopausal status and previous vaginal delivery. The difference between pain experienced versus pain expected was a major factor in patient acceptability. A vasovagal episode occurred in 5% of cases. CONCLUSION Outpatient hysteroscopy was demonstrated to be safe, effective and acceptable to women. Provision of an outpatient hysteroscopy service saves theatre time and approximately $1000 per case. Improved techniques and technology will allow progression to a 'see and treat' service, providing further savings. With budget constraints, increasing wait times for major procedures and concerns about trainee surgical experience, an outpatient hysteroscopy service should be considered the 'gold standard' investigation over hysteroscopy in theatre.
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Affiliation(s)
- Tony Ma
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Emma Readman
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Lauren Hicks
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Jenny Porter
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Melissa Cameron
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Lenore Ellett
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Kate Mcilwaine
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Janine Manwaring
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Peter Maher
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
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Lara-Domínguez MD, Arjona-Berral JE, Dios-Palomares R, Castelo-Branco C. Outpatient hysteroscopic polypectomy: bipolar energy system (Versapoint®) versus diode laser - randomized clinical trial. Gynecol Endocrinol 2016; 32:196-200. [PMID: 26527251 DOI: 10.3109/09513590.2015.1105209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the resection of endometrial polyps with two different devices: the Versapoint biopolar electrode and the Diode Laser. METHODS One hundred and two patients diagnosed with endometrial polyps were randomly assigned to undergo hysteroscopic polypectomy: one group (n = 52) performed with Versapoint bipolar electrode through a 5Fr working channel and the other group with Biolitec Diode Laser (n = 50) using a specific fiber for polyps in a 7Fr working channel. All cases were managed on an outpatient basis, without anesthesia and using a rigid 30(o) hysteroscope and saline solution as a distention medium. MAIN OUTCOME MEASURES Complete resection rate, operative time, complications, intraoperative pain and relapse rate after three months. RESULTS Intraoperative pain and polyp resection time was similar in both groups. Upon second look hysteroscopy at 3-month, a higher percentage of women of the Versapoint group presented polyp relapse (32.6 versus 2.2%, p = 0.001). Elimination of the polyp after incomplete resection was higher in the Laser group. A significantly higher number of patients in the Laser group considered the procedure to be highly recommendable (p = 0.02). CONCLUSION Polypectomy with Diode Laser resulted in fewer relapses and a higher procedure satisfaction rate as compared to Versapoint.
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Affiliation(s)
| | | | - Rafaela Dios-Palomares
- b Department of Statistics and Operational Research , University of Córdoba , Córdoba , Spain , and
| | - Camil Castelo-Branco
- c Faculty of Medicine-University of Barcelona , Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
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Closon F, Tulandi T. Future research and developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol 2015; 29:994-1000. [DOI: 10.1016/j.bpobgyn.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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McIlwaine P, McElhinney B, Karthigasu KA, Hart R. A prospective study of the use of the Myosure resectoscope to manage endometrial polyps in an outpatient setting. Aust N Z J Obstet Gynaecol 2015; 55:482-6. [DOI: 10.1111/ajo.12382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick McIlwaine
- Gynaecological Endoscopy Unit; King Edward Memorial Hospital; Subiaco WA Australia
| | | | - Krishnan Andrew Karthigasu
- Gynaecological Endoscopy Unit; King Edward Memorial Hospital; Subiaco WA Australia
- Hollywood Medical Centre; Nedlands, Perth WA Australia
- School of Women's and Infants' Health; The University of Western Australia; Crawley WA Australia
| | - Roger Hart
- School of Women's and Infants' Health; The University of Western Australia; Crawley WA Australia
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Cooper NAM, Clark TJ, Middleton L, Diwakar L, Smith P, Denny E, Roberts T, Stobert L, Jowett S, Daniels J. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study. BMJ 2015; 350:h1398. [PMID: 25801579 PMCID: PMC4370502 DOI: 10.1136/bmj.h1398] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy. DESIGN Pragmatic multicentre randomised controlled non-inferiority study. SETTING Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals. PARTICIPANTS 507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps. INTERVENTIONS Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women's self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy. MAIN OUTCOME MEASURES The primary outcome was successful treatment, determined by the women's assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure. RESULTS 73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group. CONCLUSIONS Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower. TRIAL REGISTRATION International Clinical Trials Registry 65868569.
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Affiliation(s)
- Natalie A M Cooper
- Women's Health Research Unit, Queen Mary University of London, UK OPT Trial Office, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Lee Middleton
- OPT Trial Office, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Lavanya Diwakar
- Health Economics Unit, School of Health and Population Science, University of Birmingham, UK
| | - Paul Smith
- Birmingham Women's NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, UK
| | - Elaine Denny
- Centre for Health and Social Care Research, Birmingham City University, UK
| | - Tracy Roberts
- Health Economics Unit, School of Health and Population Science, University of Birmingham, UK
| | - Lynda Stobert
- School of Allied and Public Health Professions, Birmingham City University, UK
| | - Susan Jowett
- Health Economics Unit, School of Health and Population Science, University of Birmingham, UK
| | - Jane Daniels
- OPT Trial Office, Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, Robert Aitken Institute for Clinical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Bougie O, Lortie K, Shenassa H, Chen I, Singh SS. Treatment of Asherman's Syndrome in an Outpatient Hysteroscopy Setting. J Minim Invasive Gynecol 2015; 22:446-50. [DOI: 10.1016/j.jmig.2014.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
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Centini G, Calonaci A, Lazzeri L, Tosti C, Palomba C, Puzzutiello R, Luisi S, Petraglia F, Zupi E. Parenterally Administered Moderate Sedation and Paracervical Block Versus General Anesthesia for Hysteroscopic Polypectomy: A Pilot Study Comparing Postoperative Outcomes. J Minim Invasive Gynecol 2015; 22:193-8. [DOI: 10.1016/j.jmig.2014.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/05/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
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Feasibility of Resectoscopic Operative Hysteroscopy in a UK Outpatient Clinic Using Local Anesthetic and Traditional Reusable Equipment, With Patient Experiences and Comparative Cost Analysis. J Minim Invasive Gynecol 2014; 21:830-6. [DOI: 10.1016/j.jmig.2014.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/17/2014] [Accepted: 03/15/2014] [Indexed: 11/22/2022]
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A Randomized, Single Blind, Placebo-Controlled Trial for the Pain Reduction During the Outpatient Hysteroscopy After Ketoprofen or Intravaginal Misoprostol. J Minim Invasive Gynecol 2014; 21:921-7. [DOI: 10.1016/j.jmig.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
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Gambadauro P, Martínez-Maestre MA, Torrejón R. When is see-and-treat hysteroscopic polypectomy successful? Eur J Obstet Gynecol Reprod Biol 2014; 178:70-3. [DOI: 10.1016/j.ejogrb.2014.03.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
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Bougie O, Wang V, Lortie K, Shenassa H, Singh SS. High Patient Satisfaction with Office Hysteroscopy Using Tailored Analgesia Protocols. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Olga Bougie
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vivian Wang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Lortie
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hassan Shenassa
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sukhbir S. Singh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
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New mini-resectoscope: analysis of preliminary quality results in outpatient hysteroscopic polypectomy. Arch Gynecol Obstet 2013; 288:349-53. [PMID: 23417150 DOI: 10.1007/s00404-013-2754-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We investigated the feasibility and acceptability of office hysteroscopic polypectomy using a new continuous-flow operative 16 Fr Gubbini's mini-resectoscope. This is a prospective clinical study (Canadian Task Force classification III). METHODS The office hysteroscopic polypectomy was performed with a mini-resectoscope without analgesia or anesthesia. We evaluated the polyp size and the number, the effectiveness of resection, the operating time, the pelvic pain and complications. RESULTS The office hysteroscopic polypectomy was successfully performed in all 33 patients. The polyps ranged in size from 5 to 50 mm with a mean of 18.15 ± 11.45 mm. We analyzed the operating time with a mean of 11.45 ± 4.71 min: 29 procedures took less than 15 min from the start of vaginoscopy to the end of surgery. Overall mean visual analog scale (VAS) calculated was 2.48 ± 1.37 (range 0-6). The correlation between the size of the polyps and operating time was statistically significant (p < 0.001). No major complications were recorded. CONCLUSION Our preliminary data demonstrated that can be possible to remove endometrial polyps by hysteroscopy, using the mini-resectoscope, in an office setting. All procedures were completed successfully and well tolerated with a little discomfort permitting the removal also of big sized polyps without a statistical correlation between VAS and size of polyps or operating time. The outpatient polypectomy is a less-costing procedure and represents an acceptable and effective alternative to inpatient resectoscopic polypectomy, leading to a complete polyp excision in nearly all patients.
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Surrey ES. Should Diagnostic Hysteroscopy be Performed Before In Vitro Fertilization-Embryo Transfer? J Minim Invasive Gynecol 2012; 19:643-6. [DOI: 10.1016/j.jmig.2012.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/03/2012] [Accepted: 04/05/2012] [Indexed: 01/23/2023]
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Bergamo AM, Depes DDB, Pereira AMG, Santana TCDD, Lippi UG, Lopes RGC. Polipectomia endometrial histeroscópica: tratamento ambulatorial versus convencional. EINSTEIN-SAO PAULO 2012; 10:323-8. [DOI: 10.1590/s1679-45082012000300012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 01/24/2012] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Comparar resultados da polipectomia histeroscópica endometrial efetuada ambulatorialmente, sem anestesia, com polipectomia histeroscópica convencional sob anestesia, em centro cirúrgico, avaliando taxa de sucesso, tempo de procedimento e complicações. Mensurar dor aferida pela paciente nos dois grupos. MÉTODOS: Estudo transversal observacional de 60 pacientes com diagnóstico histeroscópico de pólipo endometrial divididas em dois grupos: Grupo Ambulatorial, composto por pacientes submetidas à polipectomia histeroscópica ambulatorial, utilizando-se pinça endoscópica em histeroscópio operatório ambulatorial de fluxo contínuo, por meio de vaginoscopia sem anestesia, e Grupo Convencional com pacientes submetidas à polipectomia histeroscópica em centro cirúrgico, utilizando-se ressectoscópio monopolar sob anestesia. RESULTADOS: Os grupos foram similares quanto a idade, paridade, tipo de parto e presença ou não de menopausa. Ambos os grupos apresentaram 100% de eficácia na exérese dos pólipos. O tempo médio de procedimento foi de 7 minutos no Grupo Ambulatorial e 35,16 minutos no Grupo Convencional. No Grupo Ambulatorial, as pacientes após a menopausa (p=0,04) e aquelas com pólipos >1cm (p=0,01) apresentaram tempo de procedimento maior. Durante o procedimento,a média de dor referida pelas pacientes, segundo a Escala Analógica Verbal de Dor, no Grupo Ambulatorial, foi de 2,93 e, após efeito anestésico do procedimento no Grupo Convencional, foi de 1,42 pontos. Não houve complicações no Grupo Ambulatorial. No Grupo Convencional, registraram-se um caso de perfuração uterina e um de falso trajeto. CONCLUSÃO: A polipectomia histeroscópica realizada em regime ambulatorial, sem anestesia, é um procedimento bem tolerado. Quando comparada ao tratamento convencional, apresenta a mesma eficácia, porém com menor tempo gasto no procedimento e menor índice de complicações.
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Affiliation(s)
| | | | | | | | - Umberto Gazi Lippi
- Hospital do Servidor Público Estadual Francisco Morato de Oliveira, Brasil
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Cicinelli E, Tinelli R, Loiudice L, Loiudice I, Quattromini P, Fusco A, Cicinelli MV, Pinto V. AlphaScope vs lens-based hysteroscope for office polypectomy without anesthesia: randomized controlled study. J Minim Invasive Gynecol 2012; 18:796-9. [PMID: 22024266 DOI: 10.1016/j.jmig.2011.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 08/05/2011] [Accepted: 08/12/2011] [Indexed: 11/28/2022]
Abstract
In this randomized controlled study, effectiveness, operative time, and acceptability of endometrial polypectomy were compared using an AlphaScope vs an office operative lens-based hysteroscope (LBH). One hundred fifty women with a diagnosis of endometrial polyp were operated on using an AlphaScope or LBH in the office setting. In 73 procedures using the AlphaScope (97.3%) and 68 using the LBH (90.7%), the polyp was successfully removed completely. In the AlphaScope group, 2 procedures were incomplete because of excessive endometrial mucosa thickness. In the LBH group, 3 procedures were incomplete because of difficulty in management of a large polyp, and 4 procedures were stopped because of patient pain and low compliance. Time to completion of the procedure and complete removal of the polyp was significantly shorter in the AlphaScope group than in the LBH group (p < .05). Similarly, the pain score at the end of the procedure was significantly lower in the AlphaScope group than in the LBH group (p < .05). The AlphaScope is an effective operative hysteroscope that increases the possibility of performing endometrial polypectomy in the office setting without anesthesia and improves the indications for and acceptability of office hysteroscopy.
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Affiliation(s)
- Ettore Cicinelli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Bari, Bari, Italy.
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Current practice in the removal of benign endometrial polyps: a Dutch survey. ACTA ACUST UNITED AC 2011; 9:163-168. [PMID: 22611350 PMCID: PMC3338907 DOI: 10.1007/s10397-011-0707-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 10/01/2011] [Indexed: 10/30/2022]
Abstract
The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) p < 0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), p < 0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), p < 0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), p < 0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands.
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Anaesthesia for the elderly outpatient: preoperative assessment and evaluation, anaesthetic technique and postoperative pain management. Curr Opin Anaesthesiol 2010; 23:726-31. [DOI: 10.1097/aco.0b013e3283400b6c] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010; 17:703-8. [PMID: 20955981 DOI: 10.1016/j.jmig.2010.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/03/2010] [Indexed: 10/18/2022]
Abstract
The need for anesthesia or analgesia for performing hysteroscopy is still matter of debate. Many factors explain the lack of agreement about anesthesia in hysteroscopy depending on the instrumentation, technique employed, need of performing surgical procedure, operator skill and patients' characteristics. Diagnostic minihysteroscopy (3.5 mm or less in size) is less painful and easier to perform than hysteroscopy performed with instruments sized around 5 mm. Thanks to miniaturized instruments, office hysteroscopy allows a growing number of women to be treated in an office setting avoiding the operating room. The main limitation to its widespread use is pain and low patient tolerance. Intrauterine surgical procedures involving only the endometrial mucosa (biopsies, adhesiolisis, cervical and endometrial polyectomies) are not painful. For endometrial polypectomy size of polyps (<2.2m) and duration of the procedure (more than 15 min) are limiting factors. Most literature suggests that office hysteroscopy in experienced hands is a well-tolerated technique and requires the use of analgesics only in selected patients like women with previous caesarean section, history of chronic pelvic pain, anxiety and in menopause.
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Affiliation(s)
- Ettore Cicinelli
- Fourth Department of Obstetrics and Gynecology, Faculty of Medicine, University of Bari, Bari, Italy.
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Saridogan E, Tilden D, Sykes D, Davis N, Subramanian D. Cost-Analysis Comparison of Outpatient See-and-Treat Hysteroscopy Service with Other Hysteroscopy Service Models. J Minim Invasive Gynecol 2010; 17:518-25. [DOI: 10.1016/j.jmig.2010.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 02/25/2010] [Accepted: 03/07/2010] [Indexed: 10/19/2022]
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Gulumser C, Narvekar N, Pathak M, Palmer E, Parker S, Saridogan E. See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations. Reprod Biomed Online 2010; 20:423-9. [DOI: 10.1016/j.rbmo.2009.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 06/12/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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Hysteroscopic bipolar surgery: a valuable progress or a technique under investigation? Curr Opin Obstet Gynecol 2009; 21:329-34. [DOI: 10.1097/gco.0b013e32832e07ac] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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van Dongen H, Janssen CAH, Smeets MJGH, Emanuel MH, Jansen FW. The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding. BJOG 2009; 116:1387-90. [DOI: 10.1111/j.1471-0528.2009.02145.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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