Operative Hysteroscopy in an Office-Based Surgical Setting: Review of Patient Safety and Satisfaction in 414 Cases

Abstract

Study ObjectiveTo determine the safety and satisfaction among patients undergoing operative hysteroscopy in an office-based setting. DesignRetrospective analysis (Canadian Task Force classification II-2). SettingPhysician's private office. PatientsWomen undergoing operative hysteroscopy in an office setting. InterventionsThree hundred eighty-seven women underwent a total of 414 operative hysteroscopic procedures, with use of parenterally administered moderate sedation, a 9-mm operative resectoscope, and sonographic guidance. All patients were American Society of Anesthesiologists class I–III. Measurements and Main ResultsA total of 305 primary operative hysteroscopic procedures were performed including endomyometrial resection, myomectomy, polypectomy, removal of a uterine septum, and adhesiolysis. One hundred nine (26.3%) repeat operative procedures were performed in women in whom previous endometrial ablation and resection had failed. The average procedure required a mean (SD) of 37.6 (13.5) minutes to complete, and produced 14.1 (10.2) g of tissue. Ninety-nine percent of all procedures were completed. Only 1 patient required a hospital transfer for evaluation of a uterine perforation necessitating diagnostic laparoscopy. There were 8 (1.9%) postoperative infections, and no complications attributable to use of conscious sedation. Two hundred fifty-five women (65.6%) responded to our telephone survey. Two hundred fifty-two (98.8%) respondents were either “very satisfied” or “satisfied.” Two hundred forty-nine women (97.6%) preferred the office to a hospital setting, whereas 6 (2.4%) would have preferred a hospital setting. All but 5 respondents would recommend this procedure to a friend. ConclusionMajor operative hysteroscopic surgery can be performed in an office-based setting with a high degree of safety and patient satisfaction.