Office Hysteroscopy. Nuances of Technique

Abstract

Study Objective: To optimize hysteroscopy procedure stepping in the outpatient setting and determine patients' selection criteria.Design: Retrospective and prospective analysis of 1620 cases of hysteroscopy performed in 2007-2009.Setting: Gynecology Department, Cosmetology and Plastic Surgery Center.Patients: Total 1620 women aged 23-72 yrs with endometrial hyperplasia (n=500), endometrial polyps (412), myoma (186), developmental defects (109), uterine body endometriosis (313) and other disorders (100).Intervention: Hysteroscopy was performed as an outpatient procedure during consultation.Measurements and Main Results: Two groups of patients were compared. Group A (n=420) who underwent standard office hysteroscopy using premedication, cervical analgesia and hydraulic pump to inflate liquid into uterine cavity. Group B (n=1200) for whom saline was inflated with Riva-Rocci balloon without premedication. For subjective assessment of pain during procedure a scale 1-5 was used. Pulse, arterial pressure and saturation were used as objective assessment of patients state. In group B, 1152 (96%) patients scored their pain 1-2, 48 (4%) scored 3, higher scores were not reported. In group A the scores were: 1-2 in 50 patients (12%), 3 – 176 (42%), 4 – 151 (36%) and 5 – 42 (10%). Pain was noted to arise not from cervical canal dilation, but during liquid inflation into uterine cavity for its visualization in response to baroreceptors activity. The pressure in Group B was controlled by the amount of saline used for procedure (50-70ml), the screen image quality and objective and subjective assessment of patients. Selection criteria for procedure: patients' somatic state including allergy history, epileptic status; cervical state, probability of wider surgical intervention.Conclusion: Office hysteroscopy without a pump has certain advantages. It doesn't require: operating room setting, special preparation of a patient (could be performed at a consultation) and premedication or additional analgesia. It doesn't reduce the quality, reliability and informational content of the procedure while increasing its comfort for the patient. Study Objective: To optimize hysteroscopy procedure stepping in the outpatient setting and determine patients' selection criteria. Design: Retrospective and prospective analysis of 1620 cases of hysteroscopy performed in 2007-2009. Setting: Gynecology Department, Cosmetology and Plastic Surgery Center. Patients: Total 1620 women aged 23-72 yrs with endometrial hyperplasia (n=500), endometrial polyps (412), myoma (186), developmental defects (109), uterine body endometriosis (313) and other disorders (100). Intervention: Hysteroscopy was performed as an outpatient procedure during consultation. Measurements and Main Results: Two groups of patients were compared. Group A (n=420) who underwent standard office hysteroscopy using premedication, cervical analgesia and hydraulic pump to inflate liquid into uterine cavity. Group B (n=1200) for whom saline was inflated with Riva-Rocci balloon without premedication. For subjective assessment of pain during procedure a scale 1-5 was used. Pulse, arterial pressure and saturation were used as objective assessment of patients state. In group B, 1152 (96%) patients scored their pain 1-2, 48 (4%) scored 3, higher scores were not reported. In group A the scores were: 1-2 in 50 patients (12%), 3 – 176 (42%), 4 – 151 (36%) and 5 – 42 (10%). Pain was noted to arise not from cervical canal dilation, but during liquid inflation into uterine cavity for its visualization in response to baroreceptors activity. The pressure in Group B was controlled by the amount of saline used for procedure (50-70ml), the screen image quality and objective and subjective assessment of patients. Selection criteria for procedure: patients' somatic state including allergy history, epileptic status; cervical state, probability of wider surgical intervention. Conclusion: Office hysteroscopy without a pump has certain advantages. It doesn't require: operating room setting, special preparation of a patient (could be performed at a consultation) and premedication or additional analgesia. It doesn't reduce the quality, reliability and informational content of the procedure while increasing its comfort for the patient.