Operative hysteroscopy in the office setting

Abstract

Study Objective. To describe the feasibility of operative hysteroscopy in the office setting. Design. Descriptive study (Canadian Task Force classification II-2). Setting University-based private practice. Patients Women undergoing assisted reproduction in whom diagnostic evaluation revealed uterine cavity pathology. Intervention Patients were offered office hysteroscopy and allowed to choose between paracervical block anesthesia supplemented with mild intravenous sedation or full conscious sedation, administered by an anesthesiologist. A MicroSpan Hysteroscopy system or HysteroSys Flexible Hysteroscope system was used for diagnostic purposes. When pathology was identified, resection was performed with 2-mm operative instruments or a Versa-Point hysteroscopic electrosurgical electrode using bipolar coagulation through an expandable operating channel. Measurements and Main Results Of 69 women with abnormal sonohysterographic and hysterosalpingogram studies, 44 agreed to office hysteroscopy. Thirty-three (48%) underwent VersaPoint resection and/or scissors resection, which was successfully accomplished in 32 (97%). Significant cervical stenosis in one woman precluded resection because of concern of creating a false passage. Concomitant diagnostic laparoscopy and operative hysteroscopy was performed in one patient. Average operating and anesthesia times were 45.2±20.3 minutes and 67.2±28.4 minutes, respectively. One uterine perforation occurred (3.3%) during resection of intrauterine adhesions. Conclusion Office hysteroscopy is a time-efficient and cost-effective procedure, made possible by the development of small instruments. Proper patient selection and training of office personnel are mandatory to minimize complications and maximize efficacy.