The Impact of a Handheld Portable Hysteroscope on Physician Management Plans for Abnormal Uterine Bleeding

Abstract

Study Objective Abnormal uterine bleeding (AUB) assessment involves uterine cavity evaluation, via ultrasound (US), saline-infusion sonography (SIS), endometrial biopsy, or hysteroscopy. Reducing diagnostic delay may improve patient experience and reduce healthcare costs. A portable handheld in-office hysteroscope introduced for assessment of AUB, requiring minimal equipment and costs, is well-tolerated by patients and a safe and effective alternative to operative hysteroscopy. By ensuring prompt diagnosis and treatment and reducing further investigations, gynecological practice could be enhanced, promoting efficiency, patient and physician experience and lessening healthcare system impact. The objective of this study is to compare physician diagnosis and management plans before and after hysteroscopy at consultation for AUB. Design Prospective observational questionnaire study. Setting Canadian tertiary gynecological care center. Patients or Participants Staff gynecologists. Interventions Sixty-six uterine assessments were performed using a portable handheld hysteroscopy (Endosee, Cooper Surgical Inc.) at time of consultation for patients referred for AUB. Physicians (n=6) completed questionnaires regarding diagnoses and management plans pre- and post-procedure. Measurements and Main Results Sixty-two of 66 cases (94%) were successfully completed (reasons for incomplete procedures were cervical stenosis [n=3] and patient discomfort [n=1]), resulting in diagnosis change in 76% (n=47/62) of patients and management plan change in 92% (n=57/62) of patients, with 57% (n=35/62) of patients requiring no further surgery or imaging. In 74% (n=46/62) of cases there was an overall reduction in the number of required procedures, with 56% (n=23/41) of provisional surgical procedures and 80% (n=24/30) of provisional imaging procedures being avoided post-hysteroscopy. Normal uterine cavity was reported in 40% (n=25/62) of completed cases. Conclusion Incorporating portable handheld hysteroscopy at consultation for AUB resulted in diagnosis and management plan change in almost all cases and significant reduction of further procedures, considerably reducing delay to targeted treatment. The potential cost savings and reduced waste in our health care system should be further investigated with the introduction of this simple-to-use technology.