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

Abstract

To determine the safety and satisfaction among patients undergoing operative hysteroscopy in an office-based setting. A retrospective analysis. Physician's private office. Women undergoing operative hysteroscopy in an office-setting. Three-hundred and eighty-seven women underwent a total of 414 operative hysteroscopies utilizing an operative resectoscope, sonographic-guidance and parenterally administered moderate sedation. All patients were ASA Class I – III. A total of 283 women underwent a primary endomyometrial resection (EMR) of which 27 subjects underwent a concomitant removal of one or more endometrial polyps while another 105 patients underwent one or more myomectomies. One hundred and ten patients (26.6%) were treated for a failed resectoscopic or global endometrial ablation. Seven women (1.7%) underwent a hysteroscopic myomectomy, 1 (0.2%) underwent a septoplasty while an additional patient underwent an adhesiolysis. Finally, 12 (2.9%) asymptomatic postmenopausal women underwent an EMR because of abnormal ultrasound findings. The average procedure took 37.6 ± 13.5 minutes to complete and produced a 14.1 ± 10.2 grams of tissue. Ninety-nine percent of all procedures were completed. Only one patient required transfer to a hospital for evaluation of a uterine perforation requiring a diagnostic laparoscopy. There were 8 (1.9%) postoperative infections and no complications attributable the use of conscious sedation. A total of 259 women responded to our telephone survey (62.6%). Over 96% of the respondents were either very satisfied or satisfied; 1.9% were somewhat dissatisfied while 0.4% were very dissatisfied. Two hundred and forty eight (95.7%) preferred the office-based setting to a hospital setting. Eleven (4.2%) women would have preferred a hospital setting. Major operative hysteroscopic surgery can be performed in an office-based setting with a high degree of patient satisfaction and safety.