Distension Medium Research Articles

Influence of the examination position and distension medium on the rectal sensory test in patients with functional constipation

PurposeTo evaluate the impact of two different parameters (body position and distension medium) on the rectal sensory test in patients with functional constipation and provide data support for the development of standardized operating procedures in clinical practice.MethodsBased on a single-center process of the rectal sensory test, 39 patients with functional constipation were recruited for rectal sensory test under different body positions and distension mediums.ResultsAmong the items of the Constipation Scoring System, the score of frequency of bowel movements showed a negative correlation with the first constant sensation volume (r = -0.323, P = 0.045). Conversely, the score of painful evacuation effort showed a positive correlation with the desire to defecate volume (r = 0.343, P = 0.033). There was a statistically significant difference in the first constant sensation volume (when the distension medium was gas) measured in different body positions (left lateral position, sitting position, squatting position), and the data measured in the squatting position were significantly higher than those in left lateral position (P < 0.05). In terms of research on distension medium, it was found that the first constant sensation volume measured in the squatting position (when the distension medium was water) was significantly lower than that of gas (P < 0.05).ConclusionFor patients with functional constipation, there are differences in the results of rectal sensory tests between body positions and distension mediums. When conducting multicenter studies, it is necessary to unify the standard operating procedure (SOP) for operational details to ensure consistency and reliability of the test results.

Feasibility, safety and efficacy of high intensity focused ultrasound ablation as a preoperative treatment for challenging hysteroscopic myomectomy

Purpose To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies. Materials and methods A total of 75 patients diagnosed with types 0–III of uterine fibroids were enrolled. Based on the Size, Topography, Extension of the base, Penetration and lateral Wall position (STEPW) classification scoring system, 25 cases with a score ≥ 5 points were treated with HIFU followed by hysteroscopic myomectomy (HIFU + HM group), whereas 50 cases with a score < 5 points were treated with hysteroscopic myomectomy (HM group). Results The median preoperative STEPW score was 7 in the HIFU + HM group and 2 in the HM group. The average non-perfused volume (NPV) ratio achieved in fibroids after HIFU was 86.87%. Patients in the HIFU + HM group underwent hysteroscopic myomectomy one to four days after HIFU, and downgrading was observed in 81.81% of fibroids. The operation time for patients in the HIFU + HM group was 73 min and the success rate of myomectomy in a single attempt was 60%. The volume of distention medium used during the operation was greater in the HIFU + HM group than in the HM group (15,500 ml vs. 7500 ml). No significant difference was observed between the two groups in terms of intraoperative blood loss, the incidence of intraoperative and postoperative complications, menstrual volume score, or uterine fibroid quality of life score. Conclusion HIFU can be utilized as a preoperative treatment for large submucosal fibroids prior to hysteroscopic myomectomy. HIFU offers a novel approach in the management of this subset of patients.

Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery

Introduction and HypothesisUreteral injuries are the most feared complications of gynecological surgery and therefore intraoperative recognition is of the utmost importance. Intraoperative cystoscopy represents the diagnostics of choice to investigate ureteral patency thanks to the direct visualization of ureteral flows after administration of infusion mediums. In this study, we aimed to compare the diagnostic performance of saline versus mannitol intraoperative cystoscopy in terms of false negatives in a large cohort of patients.MethodsWe retrospectively analyzed data of patients who underwent vaginal hysterectomy and high uterosacral ligament suspension for POP. Patients were divided in two groups based on the use of saline or mannitol medium for intraoperative cystoscopy. Postoperative daily control of serum creatinine was performed until discharge, as well as urinary tract imaging, in symptomatic patients.ResultsA total of 925 patients underwent vaginal hysterectomy followed by high USL suspension for POP. Saline and mannitol medium were used in 545 patients and 380 patients respectively. Postoperative ureteral injuries were identified in 12 patients, specifically in 2% of the saline group and in 0.3% of the mannitol group.ConclusionsThe use of mannitol instead of saline as a bladder distension medium was able to significantly reduce the occurrence of postoperative ureteral sequelae.

Hysteroembryoscopy in repeated early pregnancy loss due to suspected thrombophilia

Introduction: The cause of a 1st trimester repeated pregnancy loss (RPL) under treatment with aspirin and /or heparin due to suspected thrombophilia was investigated. Using hystero-embryoscopy (HEpy) and embryo genetic analysis the embryo development was correlated to its karyotype. Patients and methods: Seventeen first trimester pregnant women recruited in the study. They all had a history of at least 2 consecutive 1st trimester recurrent miscarriages, underwent an investigation for the cause of RPL and diagnosed to suffer from hypercoagulation. Thromboprophylaxis was administrated in all 17 pregnant women during their next pregnancy, postulating that their past cause of miscarriage was due to a hypercoagulability state. Twelve patients had positive Anticardiolipin and /or Antiphospholipid antibodies and 5 patients had MTHFR high titers. Embryo autopsy was performed by hysteroscopy technique using 2.9mm – 5mm hysteroscopes, 5Fr graspers and scissors and normal saline as distending medium. The embryo morphology results were correlated with the genetic results and compared with the patients’ diagnosis and treatment during the last miscarriage. Results: HEpy revealed that in 11 out of 17 cases embryos had chromosomal abnormalities ensuring patients that the problem of their loss was not the followed treatment. In all 4 cases with decidua haematoma and umbilical cord defect patients received aspirin and LWMH, raising the possibility of anticoagulation overtreatment. Conclusion: In-situ autopsy of a miscarriage embryo can provide useful information regarding the morphology of the embryo, ruling out anatomical defects and collecting the embryo under direct vision anticipating an accurate embryo karyotyping. Embryoscopy results may assist to change the management of the next pregnancy in RPL cases and patients with hypercoagulability state.

Hysteroscopic Metroplasty Using Holmium: YAG Laser for Treatment of Septate Uterus

To demonstrate the safety, efficacy, and ease of hysteroscopic metroplasty using holmium:YAG (Ho:YAG) laser for treatment of septate uterus. Stepwise demonstration of surgical technique with narrated video footage. Septate uterus is the most common type of uterine anomaly. The incidence of uterine septum in women presenting with infertility and recurrent abortions is 15.4% [1,2]. Hysteroscopic septal incision is associated with improvement in live-birth rate in these women [3]. Hysteroscopic metroplasty for septate uterus can be done with the use of scissors and energy sources such as monopolar and bipolar electrosurgery and lasers. Ho:YAG laser is commonly used by urologists for various surgeries because of its "Swiss Army Knife" action of cutting, coagulation, and vaporization [4]. Ho:YAG laser is known for its precision. It causes lesser depth of tissue injury and necrosis and minimal collateral thermal damage compared with the electrosurgical devices and other lasers used for hysteroscopic surgery [5-8]. This is advantageous in hysteroscopic metroplasty given that it reduces the risk of uterine perforation during surgery and hence uterine rupture in the subsequent pregnancy. Reduced collateral damage to the surrounding endometrium helps promote early endometrial healing and prevent postoperative intrauterine adhesions. A 28-year-old patient with history of 2 spontaneous abortions came to our hospital for investigations. 3D transvaginal sonography of the patient showed presence of partial septate uterus with a fundal indentation of 1.5 cm (Supplemental video 1). Diagnostic hysteroscopy followed by septal incision using Ho: YAG laser was planned. We used a 2.9 mm BETTOCCHI Hysteroscope (Karl Storz SE & Co.) with a 5 mm operative sheath. Normal saline was used as the distending medium and the intrauterine pressure was maintained at 80 to 100 mm Hg. The procedure was done under total intravenous anesthesia using propofol injection. Vaginoscopic entry into the uterus (without any cervical dilatation) showed evidence of a partial uterine septum with tubal ostia on either side of the septum. A 400 micron quartz fiber was passed through a laser guide into the 5-Fr working channel of the operative hysteroscope. Ho:YAG laser (Auriga XL 50-Watt, Boston Scientific) with power settings of 15 watts (1500 mJ energy at 10 Hz) was used. Incision of the septum was started at the apex of the septum in the midline and continued in a horizontal manner from side to side toward the base (Supplemental video 2). Incision of the septum is continued till the tip of the hysteroscope can move freely from one ostium to the other (Supplemental video 3). The operative time was 12 minutes. There were no intra- or postoperative complications. Postoperative estrogen therapy was given for 2 months in the form of estradiol valerate 2 mg (tablet, Progynova, Zydus Cadila) 12 hourly orally for 25 days and medroxyprogesterone acetate 10 mg (tablet, Meprate, Serum Institute of India, Ltd) 12 hourly orally added in the last 5 days [9]. 3D transvaginal ultrasound was done on day 8 of menses. It showed a triangular uterine cavity with a very small fundal indentation of 0.37 cm. A second look hysteroscopy that was done on day 9 of menses showed an uterine cavity of good shape and size [10]. Few fundal adhesions were seen and they were incised using Ho:YAG laser. The patient conceived 5 months after the primary surgery and delivered by cesarean section at 38 weeks, giving birth to a healthy baby of 2860 grams. There were no complications during her pregnancy and delivery. A comparative study is essential to prove its advantages over other energy sources for this surgery. Hysteroscopic metroplasty using Ho:YAG laser for treatment of septate uterus is a simple, precise, safe, and effective procedure. VIDEO ABSTRACT.

Hemostatic Effect of Intrauterine Instillation of Oxytocin in Hysteroscopic Myomectomy: A Randomized Double Blinded Control Trial

Introduction: Progesterone and oestrogen can have an impact on benign smooth muscle tumours of the uterus called uterine myomas. The majority of fibroids don’t cause any symptoms and don’t need to be treated or investigated further. Fibroids originate in the smooth muscles of the uterus and move to an area of decreased resistance, where they can either stay intra-myometrial or develop into subserosal or submucous myomas. Aim of the Work: This study’s primary goal was to find out if oxytocin intrauterine infusion into the distention medium during hysteroscopic myomectomy would lessen blood loss and enhance surgical visibility. Patients and Methods: This clinical trial was undertaken at the Early Cancer Detection Unit (ECDU) at Ain Shams University hospitals using a randomised controlled double blind design. Sixty women who were scheduled for a hysteroscopic myomectomy were enrolled in this study and split into two equal groups: Group A (Oxytocin group): 10 IU of oxytocin were administered for every 1000 millilitres of the distending medium during the hysteroscopic myomectomy performed on 30 women. Group B (Placebo group): Thirty women had hysteroscopic myomectomy, and for every 1000 millilitres of the distending medium, a sterile bacteriostatic water ampule was used. Results: There was no statistically significant difference between the groups’ demographic (age) and surgical (myoma size, number, and duration of operation) data, nor were there any differences in intraoperative fluids. Each group’s Hgb and Hct decrease exhibited a significant difference, with the control group exhibiting a greater mean difference than the oxytocin group. Our findings demonstrated that there was a statistically significant difference in post-operative Hgb and HCT between groups, and that groups were similar in terms of needing blood transfusions and needing a second operation. When it came to the surgeon’s assessment of the visual fluid clarity, the groups were equivalent, but there was a statistically significant difference in the surgeons’ ratings of bleeding. According to our findings, there was no statistically significant variation in the number of uterine and medical difficulties across the groups, and the groups’ levels of complications were comparable. Conclusion: During diagnostic hysteroscopy, complications frequently arise. During a hysteroscopic myomectomy, oxytocin is infused intrauterine into the distention medium to minimise blood loss and enhance operative visibility. To confirm these results, more research using a range of doses and techniques is required.

#133 : Hysteroscopy Guided Embryo Transfer, a Newer Approach for Difficult Embryo Transfer

Background: Embryo transfer (ET) is a crucial step in IVF process. Therefore, difficult ET can significantly impact the odds of implantation. We propose that hysteroscopy guided ET might be a feasible alternative to conventional ultrasound guided ET in such cases. Case Report: This is the case of a 27-year-old woman with six years of primary infertility with severe dysmenorrhoea and menorrhagia. TVS showed a bulky adenomyotic uterus with multiple fibroids primarily in the posterior wall distorting the endometrial cavity and bilateral huge endometriomas. She underwent laparoscopic adenomyomectomy, myomectomy and bilateral Tubo-ovarian mass removal. Subsequently, she underwent IVF with donor eggs after 5 months therapy with long-acting GnRH agonist. Mock ET was attempted but was unsuccessful due to acute anterior flexion of the cervix. So, she was planned for ET under general anaesthesia, but the ET catheter could not be negotiated through the internal os. A 30∘ 3 mm hysteroscope was then inserted through the cervical canal using saline as distension media. Additionally, a small polyp was noted at the internal os blocking the entry of ET catheter. Once the endocervical canal was distended the catheter was negotiated from the side of hysteroscope into the cervical canal and it passed through the internal os easily under direct vision of hysteroscope. The hysteroscope was then withdrawn holding the catheter at its place. Complete evacuation of saline from endometrial cavity was confirmed by trans abdominal USG and a double ET was done under USG guidance. The routine post ET medication protocol was followed. Her Serum [Formula: see text]-hCG result was positive and after an uneventful pregnancy, she delivered healthy twin babies at 35 weeks. Conclusion: The introduction of hysteroscopy guided ET may be a suitable alternative in cases of difficult ET.

Hemostatic Effect of Intrauterine Instillation of Oxytocin in Hysteroscopic Myomectomy: A Randomized Double Blinded Control Trial

Introduction: Uterine myomas are benign, smooth muscle tumors of the uterus that are affected by estrogen and progesterone. Most fibroids are asymptomatic and require no intervention or further investigations. Fibroids arise from the uterine smooth muscles then migrate to a place of lower resistance becoming subserosal or submucous myomas or remains intra-myometrial. Aim of the Work: The main aim of this study was to investigate whether the intrauterine instillation of oxytocin into the distention medium during hysteroscopic myomectomy will reduce blood loss and improve surgical visibility. Patients and Methods: This Randomized controlled double blinded clinical trial was conducted at Early Cancer Detection Unit (ECDU) at Ain Shams University hospitals. This study included 60 women who were scheduled to undergo a hysteroscopic myomectomy were divided into two equal groups: Group A (Oxytocin group): 30 women underwent a hysteroscopic myomectomy with the use of 10 IU of oxytocin for every 1000 ml of the distending medium. Group B (Placebo group): 30 women underwent hysteroscopic myomectomy with the use of a sterile bacteriostatic water ampule for every 1000 ml of the distending medium. Results: Groups were comparable in demographic data (in terms of age) and surgical data sin term of (myoma size and number and duration of surgery) and intraoperative fluids and there was no statistically significant difference between groups. There were significant difference in Hgb and Hct drop in each group but control group showed more mean difference than oxytocin group. Our results showed that groups were comparable in post-operative need of blood transfusion and 2nd surgery and there was statistically significant difference between groups in post-operative Hgb and HCT. Groups were comparable in surgeon evaluation in term of visual fluid clarity and there was statistically significant difference between groups in surgeon rating bleeding. Our results showed that groups were comparable in complications in term of (uterine and medical) and there was no statistically significant difference between groups regarding complications. Conclusion: Complications during diagnostic hysteroscopy are common. Intrauterine instillation of oxytocin into the distention medium during hysteroscopic myomectomy reduce blood loss and improve surgical visibility. More studies with varied dosages and methods are needed to validate these findings.

Evaluation of the timing and safety of hysteroscopic myomectomy of large submucosal fibroids pretreated by high intensity focused ultrasound

Objectives To evaluate the timing and safety of hysteroscopic myomectomy for large submucosal fibroids pretreated with high intensity focused ultrasound (HIFU). Materials and methods From June 2011 to December 2020, 74 patients with solitary submucousal fibroid with size larger than 4 cm who received HIFU treatment followed by hysteroscopic myomectomy were enrolled. Results The average age of patients was 40.2 ± 6.7 years. Among them, 1 had type 0, 18 had type I and 55 patients had type II submucosal fibroids. The mean diameter of fibroids was 5.7 ± 1.2 cm. All patients completed HIFU in one session, and the median non-perfused volume (NPV) ratio achieved in fibroids was 90.5%. Hysteroscopic myomectomy was performed in 0–1, 1–3, 3–6, and 6–12 months after HIFU. The mean shrinkage rate of fibroids post-HIFU was 68.19 ± 19.86%, 61.10 ± 16.89%, and 63.76 ± 26.68% in 1–3 months, 3–6 months and 6–12 months, respectively. All patients completed hysteroscopic myomectomy successfully, and no intrauterine adhesion after HIFU was observed. The complete resection of fibroids achieved in 69 patients in one session of the procedure. The mean operation time was 66.66 ± 31.61 min, the median blood loss was 20 ml, and the median distention medium deficit was 275 ml. No significant difference was observed in the operation time, blood loss and distention medium deficit among patients who received hysteroscopic myomectomy at different time points (p > 0.05). Conclusions HIFU can be used as a pretreatment for large submucosal fibroids before hysteroscopic myomectomy. Based on our results, hysteroscopic myomectomy could be performed at any time point, even within 1 month after HIFU.

Hematological, Biochemical and Hemodynamic Changes during Operative Hysteroscopy using Consecutive Distension Media

ABSTRACT Background Hysteroscopy is a procedure for management of intrauterine pathology. Glycine 1.5% (200 mOsm/L) is one of the most commonly used distension media in hysteroscopy; but it carries risk of hypervolemia and dilutional hyponatremia. Objectives Studying effects of systemic absorption of irrigating fluids on hemodynamic parameters, detect fluid deficit impact on clinical outcome included biochemical, hematological parameters, conscious level, pulmonary congestion and/or edema postoperative bleeding and hospital stay. Methods Sixty patients ASA classes I & II aged between 20 and 40 years underwent elective operative hysteroscopy randomly assigned into two groups. The Study group (30 patients): where consequent saline 0.9% and glycine 1.5% were used as irrigating distension media. Control group (30 patients): where glycine 1.5% alone was used as a distension medium. Results Comparing study and control group regarding (MBP) and heart rate, they were significantly higher at recovery and 6 hours postoperatively in the control group. (CVP) readings, showed significantly higher reading in the control group at times (15 m, 30 m, 45 m after induction, six hours and after recovery). Thoracic electrical bioimpedance parameters showed that COP, Cardiac index, Stroke volume and Stroke index were significantly higher in the control group than study group at 6 hours postoperatively. Regarding serum sodium, it was significantly lower in the control group than study group at times (15 min, 30 min and 45 min intra operatively) compared to pre-induction value. Serum osmolality was lower at 6 hours in the control group. Hemoglobin, hematocrit and platelet count was lower at 6 hours among control group. Conclusion The sequential use of saline 0.9% and glycine 1.5% decreased the amount of absorbed glycine 1.5% and hence the related side effects and complications. Trial registration Clinical Trials.gov. (NCT03166228)

Comparison of prognosis of patients with endometrial cancer after hysteroscopy versus dilatation and curettage: A multicenter retrospective study.

Hysteroscopy is a useful procedure for diagnosing endometrial cancer. There is controversy regarding whether hysteroscopy affects the prognosis of endometrial cancer by prompting cancer cell into intraperitoneal dissemination. Our purpose was to confirm whether hysteroscopy could be a risk factor of the tumor stage, recurrence and survival rate of endometrial cancer. This multicenter retrospective study included all consecutive patients who had endometrial carcinoma diagnosed preoperatively with hysteroscopy and directed endometrial biopsy (HSC, group A) and dilatation and curettage (D&C, group B) between February 2014 and December 2018 at the Fujian Provincial, China. We compared the demographic feature, clinical characteristics and prognosis between the two groups. A total of 429 patients were included in the study (Group A, n = 77; Group B, n = 352). There was no significant difference between their baseline characteristics [including age, BMI, histological type and International Federation of Gynecology and Obstetrics (FIGO) stage]. By comparing several pathological conditions that may affect prognosis, there were no significant differences between the two groups in the peritoneal cytology, depth of myometrial invasion, the positivity of lymph nodes, lymphovascular space invasion and paraaortic lymph node dissection. Finally, no significant difference was found between the two groups in overall survival (OS) (P = 0.189) or recurrence free survival (RFS) (P = 0.787). Under certain inflation pressure and distension medium, hysteroscopic examination and lesion biopsy ensure the safety and have no adverse effects on prognosis compared to conventional curettage.

Complications When Infusing Massive Distending Medium in Hysteroscopic Surgery: A Review of Preventions and Cures for Operative Hysteroscopy Intravascular Absorption Syndrome (OHIA)

Objectives: Hysteroscopic surgery, as a minimally invasive gynecological diagnosis and treatment technique, has advantages including less trauma, quick recovery, and short hospital stay that are very common in clinical practice; however, certain problems remain. Using large amounts of distending medium can induce a series of body changes such as diluent hyponatremia, pulmonary edema and hypothermia. According to the 2021 Chinese Expert Consensus on anesthesia management for hysteroscopic diagnosis and treatment, the most common complication of hysteroscopic surgery was uterine perforation (0.12%), followed by operative hysteroscopy intravascular absorption syndrome (OHIA) (0.06%), intraoperative bleeding (0.03%), air embolism syndrome (0.03%), bladder or bowel injury (0.02%), and endometritis (0.01%). The incidence of uterine perforation and endovascular absorption syndrome was higher than others. With advances in both medical technology and devices, the incidence of uterine perforation has gradually decreased. Severe adhesions, multiple endometrial polyps, large uterine fibroids, etc., increase the difficulty of surgery, thus increasing operation time and the amount of fluid perfusion during surgery. OHIA has become the most important concern of clinicians during hysteroscopic surgery. At present, the prevention and treatment of OHIA remains to be further studied; accordingly, this article seeks to provide a review of current treatment modalities of OHIA during hysteroscopic surgery. Mechanism: Medline, Web of Science, and Ovid databases were searched using the following terms: distending medium, operative hysteroscopy, intravascular absorption syndrome; complications of hysteroscopic surgery. Findings in Brief: Shortening the operation time, reducing the volume of distending medium, decreasing infusion pressure, and using a bipolar scope can reduce the occurrence of OHIA during hysteroscopic surgery. Conclusions: Effective means of controlling and limiting OHIA during hysteroscopic surgery include: exploring the appropriate temperature of perfusion fluid; mastering the advanced monitoring methods; promoting the advanced surgical energy and perfusion system; and improving the surgical team’s understanding, diagnosis and treatment level of hysteroscopic surgical complications for the safety of perioperative patients’ vital signs.

Intrauterine Anesthesia in See and Treat Hysteroscopy – A Double Blind, Placebo Controlled Randomized Trial

<h3>Study Objective</h3> The primary aim of the current study is to evaluate the effect of local instillation of lidocaine in relieving pain during office operative hysteroscopy without anesthesia. Secondary aims include the rate of failure in performing the procedure and patient satisfaction among patients in the study group vs. controls. <h3>Design</h3> A randomized double-blind placebo-controlled study. <h3>Setting</h3> A university-affiliated hospital; office hysteroscopy clinic. <h3>Patients or Participants</h3> A Total of 100 patients who underwent operative office hysteroscopies were randomized with 50 in the intervention group and 50 in the control group. <h3>Interventions</h3> Ten mL of lidocaine 2% added to 1000 mL of saline solution that was used as the distension medium for hysteroscopy in the study group vs 1000 mL of saline alone in the control group. <h3>Measurements and Main Results</h3> Eighty-eight patients completed the study and were included in the analysis. The main pathology treated was retained products of conception (55 cases). A significant difference was found in the increment of pain level following the procedure measured by visual analog scale during operative stage of see and treat hysteroscopy (p=.027) and at the completion of the procedure (p=.032) between two groups. Patients' satisfaction level was similar between the two groups (88.8% for the study group and 89.3% for the control group). Success rates were also similar between the two groups at approximately 93%. No side effects were recorded in either group. <h3>Conclusion</h3> The addition of local anesthetic to the distension medium operative office hysteroscopy produces significant reduction in pain during and following the procedure without side effects.

8182 Does Menopausal Status Impact Pain Perception during in-Office Hysteroscopy? Findings from a Single-Center Study

<h3>Study Objective</h3> Hysteroscopy is considered gold standard for investigation of intrauterine pathologies. When performed in-office, patients forego the use of anesthesia and other risks associated with operating room procedures. However, fear of pain during an in-office procedure remains a deterrent factor. Previous studies have suggested that menopause is associated with increased pain during in-office hysteroscopy. The goal of our study is to evaluate the impact of menopausal status on perceived pain level during in-office hysteroscopy at our institution. <h3>Design</h3> We identified women who underwent in-office hysteroscopy using the vaginoscopy "no touch" technique at two university-affiliated clinics at our academic institution. Menopause was defined as 12 months of amenorrhea in the absence of other biological or physiological causes. At the conclusion of the procedure, perceived pain level during the procedure was self-reported on a scale from 0 to 10. <h3>Setting</h3> Hysteroscopies were performed in office procedural rooms equipped with gynecologic beds with stirrups. Patients were positioned in dorsal lithotomy position. <h3>Patients or Participants</h3> A total of 80 women were included, among which 31 patients (38.8%) were postmenopausal and 49 patients (61.3%) were premenopausal. <h3>Interventions</h3> Hysteroscopies were performed without anesthesia, using a rigid 5 mm diagnostic hysteroscope with a 30o optic (Bettocchi KARL STORZ) and normal saline as distention media at gravity. <h3>Measurements and Main Results</h3> Statistical analysis was performed via independent-sample t-test with significance set at 0.05. Average pain level was 2.45 in postmenopausal patients and 2.22 in premenopausal patients. Postmenopausal status was not a statistically significant risk factor for worse pain perception during in-office hysteroscopy (p = 0.67). <h3>Conclusion</h3> Although previous studies have described a correlation between menopausal status and increased severity of pain during in-office hysteroscopy, our study did not reveal similar results. Further studies are necessary to identify risk factors that influence the pain experienced by patients during in-office hysteroscopy to better guide gynecologists when planning diagnostic approaches to intrauterine pathologies.

Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the visual analog scale (VAS) during and after the procedure. Our secondary outcome was the patient satisfaction between both groups. Five RCTs met our inclusion criteria with a total number of 441 patients. We found warm saline was linked to a significant reduction in the VAS pain score during the procedure compared to the control group (mean difference [MD] = -1.12, 95% confidence interval [CI] [-1.80, -0.45], p = 0.001). Moreover, the VAS pain score after the procedure was significantly declined among the warm saline group (MD = -0.62, 95% CI [-0.97, -0.27], p = 0.005). Interestingly, more patients were significantly satisfied with warm saline distension medium application compared to room temperature group (odds ratio [OR] = 3.71, 95% CI [2.01, 6.86], p < 0.001). Warm saline application in office hysteroscopy is effective in reducing pain during and after the procedure as well as improvement in patient satisfaction.

Assessment of Pain at Different Steps of Diagnostic Hysteroscopy Using Room Temperature Normal Saline versus Warmed Normal Saline Solution as Distension Medium: A Randomized Controlled Trial.

Objectives:Compare pain intensity at entry into the cervical os, during uterine distension and 15 min after the procedure, in patients undergoing diagnostic hysteroscopy with room temperature normal saline versus that with saline warmed to 38–40°C, using visual analog scale (VAS) score. Furthermore, compare the time taken and failed procedures between them.Materials and Methods:This was a randomized controlled, prospective study conducted at a Tertiary Care Center on 100 patients planned for diagnostic hysteroscopy with a 4 mm 30° hysteroscope using vaginoscopy technique. They were divided into two groups of 50 each, with control undergoing the procedure using normal saline at room temperature and the test with saline warmed to 38–40°C as distension medium. Primary outcomes were VAS at the point of entry into the internal os (T0), 1 min later (T1), and 15 min after the procedure (T15). Secondary outcomes were procedural acceptance, time taken, and failed procedures.Results:The mean VAS in the control group at T0, T1, T15 was 3.31 (1.461;‒0.870–0.245), 2.46 (1.398;‒0.539–0.498), 0.75 (0.911;‒0.379–0.338), respectively, as compared to the test group of 3.62 (1.282;‒0.870–0.245), 2.48 (1.148;‒0.540–0.498), 0.77 (0.911;‒0.379–0.379), respectively. About 73.5% of controls and 68.8% in the test group were willing to undergo the procedure again. About 93.9% of controls would recommend it further as against 93.8% among the test controls. The time taken and number of failed procedures showed no statistical difference.Conclusion:No significant difference was noted in terms of outcomes measured by warming the distension medium.

Outcomes of surgical hysteroscopy: 25 years of observational study

The aim of this prospective study was to analyse the complications of operative hysteroscopy over the last 25 years and determine whether such complications were related to patient characteristics, surgery type, surgical time or distension-medium balance. Three thousand and sixty-three operative hysteroscopies were performed; 52.7% were polypectomies and 31.5% were myomectomies. Myectomies had the highest incidence of complications, at 14%, followed by septolysis, at 6.9%. The most common complications were mechanical (52%). Myomectomies had seven times higher risk than polypectomies of distension-medium complications (RR 7.5, p<.001) but three times lower risk of mechanical complications (RR 0.32, p<.001). The highest incidence of complications occurred in type I myomas and those larger than 3 cm. If we define fluid-balance complications as only those patients who absorbed more than 1.5 L and developed related symptoms, our overall complication rate, including all mechanical complications, was 5.6%. Impact Statement What is already known on this subject? In recent years, the importance of properly preventing and managing hysteroscopic complications has risen in line with the number of diagnostic and operative hysteroscopies performed. Complications in operative hysteroscopy differ between surgery types, patient characteristics and the distending media used. What do the results of this study add? This study provides data from a high number of patients compared to previously published studies on the complications of operative hysteroscopies, and includes a study of the relationship between type of surgery and type of complication. What are the implications of these findings for clinical practice and/or further research? Our study shows the importance of a good preoperative assessment, since the complications of hysteroscopy differ greatly depending on the indication. Thus, within myomectomies, knowing the exact type, size and location of the myoma will allow the surgeon to carefully plan the procedure to avoid complications.

Uterine distension media for outpatient hysteroscopy.

Uterine distension media for outpatient hysteroscopy.

Hysteroscopy in COVID 19 pandemic: safety concerns.

The coronavirus disease (COVID-19) pandemic is a global health crisis that negatively impacts the health infrastructure by diverting resources to manage this infection. The long-term impact on the health of patients due to a lack of appropriate medical care to avoid COVID-19 infection is already visible in the mortality rates of the general population. The presence of the severe acute respiratory syndrome coronavirus 2 in the female genital tract is not clear. Bubbles produced during hysteroscopy tend to cool down to the temperature of the distension medium and then dissolve. Hence, aerosols are not produced during hysteroscopy, which is usually performed in an office setting. If anesthesia is required, conscious sedation or regional anesthesia should preferably be used to reduce aerosol production. Hence, hysteroscopy is not an aerosol-generating procedure and the risk of COVID-19 infection is low; therefore, hysteroscopy should not be ruled out in emergencies.

STUDY OF DIAGNOSTIC HYSTEROSCOPY IN PERI AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING

Background:Abnormal uterine bleeding is dened as bleeding from uterus that differs from that of usual normal menstrual bleeding, in frequency of occurrence or in amount or in alteration of ow. The advantages of hysteroscopy as an accurate diagnostic technique are that it not only allows direct visual observation of pathology but also provides a means to sample the site, most likely to yield positive results. The present study was conducted to study the role of Hysteroscopy in abnormal uterine bleeding in Peri and Post-menopausal women at a tertiary care hospital. Material And Methods: Present study was single-center, prospective, Cross sectional study, conducted in women age ≥40years with heavy menstrual bleeding, prolonged bleeding, frequent menstruation, intermenstrual bleeding and post coital bleeding, Post-menopausal bleeding. Hysteroscopy was performed preferably in post-menstrual phase or post bleeding phase with a standard 4mm hysteroscope(Stryker) with a 30 degree fore-oblique lens. Procedure was performed under IV sedation with normal saline as distention media. Results: In present study, majority of the subjects (n=28) i.e. 36.8% presented with heavy menstrual bleeding followed by prolonged bleeding (32.8%), post- menopausal bleeding (21%), frequent menstruation (7.89%) and inter-menstrual bleeding (1.3%). On hysteroscopy normal ndings were present in 32 subjects (42%) followed by hyperplasia (17.1%), atrophic endometrium (13.1%), submucous broid (14.4%), endometrial growth (2.96%) &amp; broid polyp (1.36%). Histopathology examination noted Proliferative endometrium (31.5%), secretory (10.5%), disordered proliferative phase (1.3%), simple hyperplasia (18.4%), complex hyperplasia with atypia (1.3%), submucous broid (14.4%), endometrial polyp (34.2%), atrophy (13.1%), broid polyp (1.34%) and malignancy (3.96%). Sensitivity, Specicity, PPV, NPV values were 100 % except for sensitivity for endometrial growth (66.7 %). p Value was highly signicant for all parameters (p &lt;0.0001) Conclusion: Hysteroscopy has a better diagnostic accuracy as it provides the option of see and treat which is recommended for peri and post-menopausal women with AUB.. The intracavitary lesions (submucous leiomyomas, polyps, endometrial growth are) better diagnosed on hysteroscopy