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Vitagliano A, Dellino M, Favilli A, D' Amato A, Nicolì P, Laganà AS, Noventa M, Bochicchio MA, Cicinelli E, Damiani GR. Patients' Use of Virtual Reality Technology for Pain Reduction during Outpatient Hysteroscopy: A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2023; 30:866-876. [PMID: 37648150 DOI: 10.1016/j.jmig.2023.08.427] [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: 06/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To summarize evidence from randomized controlled trials (RCTs) on the effectiveness of virtual reality technology (VRT), as used by patients, for reducing pain during outpatient hysteroscopy. DATA SOURCES Electronic databases and clinical registers were searched until June 21, 2023. The review protocol was registered in PROSPERO before the data extraction (CRD42023434340). METHODS OF STUDY SELECTION We included RCTs of patients receiving VRT compared with controls receiving routine care during outpatient hysteroscopy. TABULATION, INTEGRATION, AND RESULTS The primary outcome was average pain during hysteroscopy. Pooled results were expressed as mean differences (MDs) with 95% confidence interval (CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. Five RCTs were included (435 participants). The comparison between the intervention and control groups showed a borderline difference in perceived pain during hysteroscopy (MD -0.88, 95% CI -1.77 to 0.01). Subgroup analysis based on the type of VRT (active or passive) indicated that active VRT potentially reduced the perception of pain (MD -1.42, 95% CI -2.21 to -0.62), whereas passive VRT had no effect (MD -0.06, 95% CI -1.15 to 1.03). CONCLUSION Patients' use of active VRT may be associated with a reduction in pain during outpatient hysteroscopy (evidence Grading of Recommendations Assessment, Development, and Evaluation 2/4). Future research should focus on conducting methodologically robust studies with larger sample sizes and more homogeneous populations.
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Affiliation(s)
- Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy.
| | - Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery (Drs. Favilli), University of Perugia, Perugia, Italy
| | - Antonio D' Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Pierpaolo Nicolì
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) (Dr. Laganà), University of Palermo, Palermo, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health (Dr. Noventa), University of Padua, Padua, Italy
| | | | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
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Gawron I, Baran R, Zmaczynski A, Babczyk D, Jach R, Pietrus M. Nonsteroidal anti-inflammatory drug with a local anesthetic compared to nonsteroidal anti-inflammatory drug alone significantly reduce the pain associated with vaginoscopic office hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2023; 288:61-66. [PMID: 37451130 DOI: 10.1016/j.ejogrb.2023.07.005] [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: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Pain is the most common cause of office hysteroscopy (OH) failure. There is no consensus on alleviation of pain during OH. The aim was to compare the effectiveness of pain-relieving methods during OH. STUDY DESIGN A prospective randomized open-label trial included women subjected to OH. All women received 100 mg of ketoprofen intravenously pre-procedure. Women were randomly assigned to 3 arms: A) no local anesthesia, B) infiltration anesthesia with 20 ml of 1% lidocaine solution, C) paracervical block with 20 ml of 1% lidocaine solution. Karl Storz Bettocchi® rigid hysteroscope with a 5 mm operative sheath was used. Intensity of pain in numeric rating scale (NRS), intensity of cervical bleeding, frequency of vasovagal episodes, and failure rate were compared. RESULTS The study involved 201 women, 67 in each arm. NRS value during OH was higher in arm A than in B and C (6.3 vs. 5.1 vs. 5.0; p = 0.01). NRS value after OH did not differ and in all arms pain was imperceptible (p = 0.007). Cervical bleeding was more frequent in arm B than in A and C (76.1% vs. 33.4% vs. 35.9%; p < 0.0001), but its intensity did not differ from the other arms (p = 0.3). Vasovagal episode was most common in arm B (p = 0.048). There was no difference in the failure rate between the arms (p = 0.08). CONCLUSIONS The paracervical block, albeit technically the most laborious, has proven to be the most beneficial for the patient in terms of overall comfort and for the surgeon regarding feasibility.
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Affiliation(s)
- Iwona Gawron
- Jagiellonian University Medical College, Faculty of Medicine, Department of Gynecology and Obstetrics, Kopernika 23, 31-501 Krakow, Poland; University Hospital in Krakow, Clinical Department of Gynecological Endocrinology and Gynecology, Kopernika 23, 31-501 Krakow, Poland.
| | - Rafał Baran
- University Hospital in Krakow, Clinical Department of Gynecological Endocrinology and Gynecology, Kopernika 23, 31-501 Krakow, Poland.
| | - Andrzej Zmaczynski
- Jagiellonian University Medical College, Faculty of Medicine, Department of Gynecology and Obstetrics, Kopernika 23, 31-501 Krakow, Poland; University Hospital in Krakow, Clinical Department of Gynecological Endocrinology and Gynecology, Kopernika 23, 31-501 Krakow, Poland.
| | - Dorota Babczyk
- University Hospital in Krakow, Clinical Department of Gynecological Endocrinology and Gynecology, Kopernika 23, 31-501 Krakow, Poland.
| | - Robert Jach
- Jagiellonian University Medical College, Faculty of Medicine, Department of Gynecology and Obstetrics, Kopernika 23, 31-501 Krakow, Poland; University Hospital in Krakow, Clinical Department of Gynecological Endocrinology and Gynecology, Kopernika 23, 31-501 Krakow, Poland.
| | - Milosz Pietrus
- Jagiellonian University Medical College, Faculty of Medicine, Department of Gynecology and Obstetrics, Kopernika 23, 31-501 Krakow, Poland; University Hospital in Krakow, Clinical Department of Gynecological Oncology and Gynecology, Jakubowskiego 2, 30-688 Krakow, Poland.
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van Wessel S, Rombaut J, Vanhulle A, Emanuel MH, Hamerlynck T, Weyers S. Efficacy of Oral Nifedipine, Naproxen, or Placebo for Pain Relief During Diagnostic Hysteroscopy in an Office Setting: A Randomized Pilot Study. J Minim Invasive Gynecol 2023; 30:473-479. [PMID: 36804576 DOI: 10.1016/j.jmig.2023.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
STUDY OBJECTIVE To compare nifedipine, naproxen, or placebo for pain relief during diagnostic hysteroscopy. DESIGN Double-blind, randomized controlled pilot study. SETTING University hospital. PATIENTS Women scheduled for office diagnostic hysteroscopy (n = 60). INTERVENTIONS Women received nifedipine (2 tablets of 10 mg), naproxen (2 tablets of 250 mg), or placebo (2 tablets of 500 mg lactose) 30 to 60 minutes prior to hysteroscopy. MEASUREMENTS AND MAIN RESULTS Sixty patients were enrolled in the study (21 in the nifedipine group, 19 in the naproxen group, and 20 in the placebo group). The median pain scores during hysteroscope insertion, measured on a Visual Analog Scale (VAS), were 1 (interquartile range (IQR) 0-0), 2 (0-4) and 1 (0-1) in the nifedipine, naproxen and placebo group, respectively (P,14). The median VAS scores during hysteroscopy were 5 (IQR 2-7), 5 (4-8) and 5 (3-7) in the nifedipine, naproxen and placebo group, respectively (P,73). The median VAS scores immediately after hysteroscopy were 2 (IQR 0-4), 3 (0-6) and 3 (1-5) in the nifedipine, naproxen and placebo group, respectively (P,40). The median VAS scores 30 minutes after hysteroscopy were 1 (IQR 0-2), 1 (0-1) and 1 (0-2) in the nifedipine, naproxen and placebo group, respectively (P,63). Hysteroscope insertion failed in 1 case (naproxen group) because of cervica`l stenosis (P,32). Flushes, fatigue and vertigo, 30 minutes after the procedure, were significantly more prevalent in the nifedipine group compared to the naproxen (p < .001, p,03, p,03, respectively) and the placebo group (p < .001, p,01, p,01, respectively). Palpitations occurred only in the nifedipine group (p < .001). The day after the procedure, the headache was most prevalent in the nifedipine group compared to the naproxen group (p,001) and the placebo group (p,001). CONCLUSION In our pilot study, pain relief and success rates for office diagnostic hysteroscopy were not significantly different between nifedipine, naproxen, and placebo. Nifedipine was associated with more, albeit tolerable, side-effects.
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Affiliation(s)
- Steffi van Wessel
- Women's Clinic, Ghent University Hospital (Drs. Wessel, Rombaut, Vanhulle, Hamerklynck, Weyers), Ghent, Belgium.
| | - Julie Rombaut
- Women's Clinic, Ghent University Hospital (Drs. Wessel, Rombaut, Vanhulle, Hamerklynck, Weyers), Ghent, Belgium
| | - Astrid Vanhulle
- Women's Clinic, Ghent University Hospital (Drs. Wessel, Rombaut, Vanhulle, Hamerklynck, Weyers), Ghent, Belgium
| | - Mark Hans Emanuel
- Women's Care, Bergman Clinics (Dr. Emanuel), Hilversum, Netherlands; Department of Reproductive Medicine and Gynecology, University Medical Center (Dr. Emanuel), Utrecht, The Netherlands
| | - Tjalina Hamerlynck
- Women's Clinic, Ghent University Hospital (Drs. Wessel, Rombaut, Vanhulle, Hamerklynck, Weyers), Ghent, Belgium
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital (Drs. Wessel, Rombaut, Vanhulle, Hamerklynck, Weyers), Ghent, Belgium
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Kovalak EE. Does “no-touch” technique hysteroscopy increase the risk of infection? Turk J Obstet Gynecol 2022; 19:145-151. [PMID: 35770455 PMCID: PMC9249365 DOI: 10.4274/tjod.galenos.2022.04272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Today, thanks to its many advantages, hysteroscopy with a vaginoscopic approach (no-touch) is increasingly being used more in outpatient diagnoses and treatments. However, there are concerns that the “no-touch” technique increases ascending genital tract infections since a speculum is not inserted, and disinfection of the cervix cannot achieve. Materials and Methods: Between 2011 and 2017, 302 patients who underwent office hysteroscopy with the vaginoscopic approach (group 1) and 254 patients who underwent hysteroscopy with the standard method under anesthesia in the operating room (group 2) were compared in terms of early complications (within two weeks postoperatively). The primary outcome was early postoperative infection, and the secondary outcome was other early complications, such as bleeding and rupture. Results: In this study, the success rate of hysteroscopy with the vaginoscopic approach was 96.4%. According to the visual analog scale scoring system, 88.7% of the patients described mild-to-moderate pain. When group 1 and 2 were compared in terms of postoperative infection (3% and 2.4%, respectively) and other early complication rates (0% and 0.8%, respectively), no statistically significant difference was found (p>0.05). Conclusion: Hysteroscopy with a vaginoscopic approach continues to be the gold standard method that is safe and well-tolerated by patients.
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Raz N, Sigal E, Gonzalez Arjona F, Calidona C, Garzon S, Uccella S, Laganà AS, Haimovich S. See-and-treat in-office hysteroscopy versus operative hysteroscopy for the treatment of retained products of conception: A retrospective study. J Obstet Gynaecol Res 2022; 48:2459-2465. [PMID: 35698805 PMCID: PMC9541046 DOI: 10.1111/jog.15327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
AIM To compare the efficacy and safety of in-office hysteroscopy with a see-and-treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC). METHODS We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy. Between 2018 and 2019, all cases of RPOC less than 2 cm in size were hysteroscopically removed by the see-and-treat approach in the office setting. Sociodemographic, clinical, and procedure characteristics along with complications were retrieved from medical records. RESULTS Between 2015 and 2019, 119 women underwent hysteroscopic removal of RPOC equal to or smaller than 2 cm: 53 patients by in-office hysteroscopy, and 66 by operative hysteroscopy. The two groups were similar in preoperative characteristics. Although the time required to complete the RPOC removal was similar, the total procedure and assistant time were significantly higher in the operative hysteroscopy group (p < 0.001). Moreover, operative hysteroscopy was associated with a higher proportion of cases complicated by excessive bleeding, cervical tear, or uterine perforation (p = 0.016). Failure to complete the procedure was similarly reported in the two groups (p = 0.58). CONCLUSIONS In-office hysteroscopy with the see-and-treat approach for RPOC equal to or smaller than 2 cm appears as effective as operative hysteroscopy, but safer. In-office hysteroscopy may be considered the first choice for treating RPOC equal to or smaller than 2 cm.
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Affiliation(s)
- Nili Raz
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emiliya Sigal
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Fernando Gonzalez Arjona
- Department of Obstetrics and Gynecology, Hospital Regional Materno Infantil de Alta Especialidad, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Carmelo Calidona
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Hysteroscopy Unit. Del Mar University Hospital, Barcelona, Spain
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