Office operative hysteroscopy: a retrospective review

Abstract

Introduction: The indications for hysteroscopy have expanded including, beside diagnosis, treatment procedures that ideally could and should be performed, in the majority of cases, in an outpatient setting. The objectives of this report were to present and analyse the data from one year office operative hysteroscopies performed in our Department. Methods: Retrospective review of the clinical files of the women submitted to office operative hysteroscopies, performed without anesthesia, last year in our Department. Data analysis included not only main indications, hysteroscopic findings and procedures, complications, pain scale, and histological study, but also patients’ clinical data, such as age, parity, type of delivery, and hormonal status. Results: From the 513 office hysteroscopies performed during last year in our department, 228 (44,4%) were operative. Main indications, responsible for 93.9% of the operative hysteroscopies, were suspicion of an endometrial polyp, in 37.1% of the cases, followed by endometrial thickening, in 34.5%, and sterilization with Essure, in 22.3%. When the indication to perform the hysteroscopy was the suspicion of an endometrial polyp, one or more polyps were found in 72 cases (83.7%), with the other cases being associated more frequently to a non-pathological endometrium but also to the presence of synechiae, myomas or endometrial focal hypertrophy. Considering the cases of endometrial thickening, the most frequent findings included polyps, non-pathological endometrium, endometrial hypertrophy, and irregular formations with increased vascularization. The most frequent procedures performed were byopsies, in 87 cases, polypectomies, in 81 cases, and Essure insertion for hysteroscopic sterilization in 48 cases. About the pain scale (from 0 to 10), the minimum and maximum referred by the patients were 0 and 10, with the average being 3.9. Regarding complications, there were two cases of vasovagal reactions and one case of severe bleeding; about technical difficulties, there were 4 cases of failed attempt to introduce the Essure, in 3 cases unilaterally and in 1 case bilaterally, due to ostia stenosis. In the majority of cases the histological analysis showed benign findings; there were report of 7 cases of adenocarcinoma, 1 case of a poorly differentiated carcinoma, 2 case of malignant mullerian tumor, and 3 cases of complex hyperplasia with atypia. Conclusions: The use of office operative hysteroscopy has been increasing due to the fact that this is a “time-efficient and cost-effective procedure” with a high success rate. Thereby, in our department, there has been an increasing in the procedures performed under these conditions, with no deterioration in success, failure or complication rates. One of the problems usually described by authors is the pain associated, however, in our case, we had scarce cases of women that referred severe pain, with the average pain scale being between minor and moderate.