Flexible Hysteroscopy Research Articles

A comparison of outpatient hysteroscopy with saline infusion hysterosonography

Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy. Design Prospective, parallel, blinded comparative study. Setting Outpatient hysteroscopy clinic in a large university teaching hospital. Population All women referred for outpatient hysteroscopy in a 15-month period. Interventions Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result. Main outcome measures The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test. Results One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy. Conclusions Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.

A prospective evaluation of pain and acceptability during outpatient flexible hysteroscopy and endometrial biopsy

AbstractObjective To compare the pain of outpatient flexible hysteroscopy and endometrial sampling in women who have abnormal uterine bleeding.Design A prospective cohort study.Setting A minimal access gynaecological training unit within a district general hospital in north‐east England.Subjects 100 women referred consecutively for assessment of abnormal uterine bleeding.Main outcome measures Pain experienced with hysteroscopy and endometrial biopsy, as assessed by visual analogue score, and patient acceptability assessed by questionnaire.Results Endometrial biopsy was found to be the most painful part of the assessment and was significantly more painful than either hysteroscopy or insertion of the speculum (P < 0.0001). The overall success of outpatient hysteroscopy in this series was 93%. On an intention‐to‐treat basis, procedure acceptability was 92% and only 9% of women required additional oral analgesia following the procedures. Of the women, 51% found the experience of outpatient hysteroscopy less painful than a cervical smear.Conclusion Outpatient flexible hysteroscopy is a viable first‐line investigation for abnormal uterine bleeding. Endometrial biopsy should be used selectively.

Modified Sonohysterography Immediately after Hysteroscopy in the Diagnosis of Submucous Myoma

Study Objective To report a new, convenient, inexpensive, office-based examination to evaluate submucous myomas before hysteroscopic myomectomy. Design Retrospective analysis (Canadian Task Force classification II-2). Setting University-affiliated teaching hospital. Patients One hundred seventy-nine consecutive women. Intervention Diagnostic flexible hysteroscopy and transvaginal ultrasonography. Measurements and Main Results Transvaginal ultrasonography was performed immediately after hysteroscopy. The size and depth of invasion of submucous myomas were clearly identified by retained fluid after hysteroscopy. Locations of myomas were as follows: anterior wall, 37 (20.7%); posterior wall, 52 (29.1%); lateral wall, 40 (22.3%); and fundus, 31 (17.3%); and multiple myomas, 19 (10.6%). Myomas with stalk were found in 101 patients (56.4%) and without stalk in 78 (43.6%). The mean myoma diameter was 2.95 ± 2.12 cm and mean weight was 30.2 ± 33.6 g. Conclusion It is important to obtain details as to size and depth of invasion of submucous myomas before hysteroscopic myomectomy. Sonohysterography immediately after hysteroscopy is superior to traditional diagnostic methods.

Ovaoffice flexible hysteroscopy to diagnose endometrial cancer

Ovaoffice flexible hysteroscopy to diagnose endometrial cancer

Lin's outer sheath for continuous-flow system of flexible hysteroscopy

Lin's outer sheath for continuous-flow system of flexible hysteroscopy

Management of septate uterus by flexible hysteroscopy and Nd:YAG laser

Objective: To evaluate the efficiency of flexible Nd-YAG laser hysteroscopic metroplasty. Methods: We present a retrospective study of 17 patients treated for septate uteri between 1990 and 1995. The indication of hysteroscopy was recurrent abortion in nine cases and eight with primary infertility with indication of IVF in another five cases. We did not prescribe any pretreatment. A flexible hysteroscope with a 100-W Nd:YAG laser was used with glycine-controlled flow. The septum was divided by the laser after exploration of the cavity. We proposed a control office hysteroscopy 2 months after surgery to prevent uterine adhesions. Results: There was no complication. Twelve patients conceived with 10 live births at term and two spontaneous abortions. Four are still infertile, two were lost from the study and two no longer desired pregnancy. Resectoscopic studies showed the same results. Conclusion: The advantages of this method are the excellent ergonomic properties of the fibroscope and the safety of the laser. We suggest that metroplasty does not improve the pregnancy rate but only the pregnancy outcome of these patients. However, for those with the indication of IVF the procedure seems useful in avoiding abortion.

Blind endometrial biopsies: insufficient for diagnosis in women with intrauterine pathology

ObjectiveTo evaluate blind and directed endometrial biopsies for histological diagnosis in the presence of intrauterine pathology.DesignA prospective study comparing the information obtained at outpatient hysteroscopy with undirected endometrial biopsy with subsequent pathological findings obtained after transcervical resection (TCR) of intrauterine polyps.SettingThe Department of Obstetrics and Gynaecology, The Royal Surrey County Hospital, Guildford, 1991–1996.Subjects414 women who were diagnosed as having intrauterine abnormalities, 177 of whom opted for transcervical resection.Main outcome measuresOutcomes of referrals to a ‘one‐visit clinic’, with particular reference to that group of patients undergoing TCR. Comparisons between the histological findings obtained from blind endometrial biopsy and those from TCR specimens.Results414/1022 women had intrauterine abnormalities identified by flexible hysteroscopy, and 177 (42.8%) opted for TCR. The histological findings from the TCR specimens differed from the endometrial biopsies by 30% overall, and the discrepancies included two carcinomas and three complex hyperplasias with atypia.ConclusionWe suggest that, in women with abnormal uterine bleeding, the use of blind endometrial biopsy alone as a screening technique should be questioned. Outpatient hysteroscopy should be offered to women with abnormal uterine bleeding, with directed biopsy or transcervical resection for those in whom intrauterine polyps have been identified.

Flexible outpatient hysteroscopy without anaesthesia: a safe, successful and well tolerated procedure.

The objective of this study was to assess the feasibility and tolerance of diagnostic outpatient flexible hysteroscopy without anaesthesia. Records from 554 consecutive patients were analysed retrospectively. Success rate, reasons for failure, adverse reactions and level of pain were the main outcome measures. Hysteroscopy was successful in 90.5% of patients and well tolerated in 93.3%; 5.4% experienced moderate to severe pain. Inability to negotiate the cervical canal accounted for 47% of failed procedures and poor view for 42%. These results suggest that flexible outpatient hysteroscopy without anaesthesia is a successful and well tolerated procedure.

Flexible hysteroscopy: an outpatient evaluation in abnormal uterine bleeding

ObjectiveTo investigate the value of including flexible hysteroscopy as an investigative procedure as part of a one‐stop outpatient clinic for the investigation of abnormal uterine bleeding.DesignA prospective study comparing the information obtained at outpatient hysteroscopy with that detected by gynaecological examination and undirected endometrial biopsy. Transvaginal ultrasound was used as an adjunct to these investigations and no formal comparison was made per se between this and hysteroscopy.SettingThe Abnormal Uterine Bleeding (AUB) Clinic, The Royal Surrey County Hospital, Guildford 1991–1996.SubjectsThese were 1022 women (age range 18–86 years) referred by their general practitioners because of abnormal uterine bleeding. No other referral criteria, such as age, were enforced.Main outcome measuresIncidence of benign and malignant gynaecological pathology.ResultsThe true failure rate where hysteroscopy was indicated and attempted was 2.7%. No significant pathology was identified in any patient under the age of 25 years. The incidence of confirmed malignancy was 6.84 per 1000. The percentage of the total pathology identified by hysteroscopy alone, in the age group 35–39 years, was 37 out of 65 abnormalities (56.9%). This was significantly greater than in the age group 25–34 years (P = 0.017), where 16 out of 47 abnormalities (34.0%) were identified. There was no significant difference between the 35–39 and the 40–89‐years age group (P = 0.078) in which hysteroscopy identified 224 out of 494 abnormalities (45.3%).ConclusionFlexible hysteroscopy applied on an outpatient basis is a simple and safe investigation, acceptable to patients, which greatly enhances the detection and characterization of intrauterine pathology allowing appropriately directed treatment options. In our series the incidence of intrauterine adhesions was 1.5%, endometrial polyps 13.7%, and submucous fibroids 14.6%. We would recommend that: hysteroscopy should not be performed on women under 25 years of age; outpatient hysteroscopy should be offered as a first‐line investigation to all women over the age of 35 years presenting with abnormal uterine bleeding.

Eight years' experience performing procedures with flexible hysteroscopes

Flexible hysteroscopy is a valuable technique with a wide range of applications in gynecology and infertility. Its design, characteristics, and applications make it an important addition to the instruments available to gynecologic surgeons.

State-of-the-art flexible hysteroscopy for office gynecologic evaluation

To evaluate office flexible hysteroscopy without anesthesia with regard to pain, inconvenience and cost. A survey of patients to evaluate the level of pain they experienced during office hysteroscopy, and a comparison of costs for these procedures with those of hospital dilatation and curettage. Office-based hysteroscopy suite in the outpatient building of a tertiary institution. Women referred to this institution for gynecologic evaluation between February 1992 and December 1993. Diagnostic flexible hysteroscopy without anesthesia, cervical dilatation, or paracervical block. A total of 417 women (mean age 42 yrs, range 16-84 yrs; 78 postmenopausal) were referred for evaluation during the study period. The most common indication for referral was abnormal uterine bleeding (86%). Hysteroscopy could not be completed in 29 women (7%), primarily because of cervical stenosis. Pain ratings obtained from 387 patients were as follows: easily acceptable discomfort, minimal discomfort during procedure, 133 (34.5%); acceptable discomfort, uncomfortable but easily bearable, 86 (22.2%); tolerable discomfort, equivalent to menstrual cramps and spasms, 106 (27.4%); barely tolerable pain, tolerable for short time only, 48 (12.4%); and intolerable pain, severe enough to stop the procedure before completion, 14 (3.6%). A single adverse event, a postprocedure temperature elevation, was easily treated with oral antibiotics. No pathology was identified in 183 (43%) of the women; 95 (22%) had polyps and 90 (21.5%) had fibroid tumors. The average duration of a procedure was 5 minutes. The charge for office hysteroscopy was $475. Flexible office hysteroscopy without anesthesia was well tolerated by the majority of the women. In addition, the procedure is far less expensive and time consuming than when it is performed in an operating room. We believe that it is a safe, well-tolerated, and cost-effective procedure of great diagnostic value.

Clinical applications of Lin's forceps in flexible hysteroscopy

Eighty-one patients underwent directed biopsy with a large Lin's biopsy forceps during flexible hysteroscopy performed without cervical dilatation or anesthesia. Ninety-seven specimens were obtained, with an average size of 74.5 mm 3. For control study, 18 women underwent directed biopsy with a small conventional biopsy forceps. Nineteen specimens were obtained, with average size 3.4 mm 3 (p<0.05). In eight women, lost intrauterine devices were retrieved with a large Lin's grasping forceps, which can easily grasp the device directly and remove it during flexible hysteroscopy.

Transcervical tubal catheterization utilizing flexible hysteroscopy is an effective method of treating cornual obstruction: A review of 120 cases

The author reviewed a 3 year experience in the treatment of bilateral cornual obstruction using an Olympus 4.7 mm flexible, operating hysteroscope (Olympus HYF-P) with a modified Katayama transcervical tubal catheter (Cook, Inc.) and concomitant laparoscopy. Of 120 patients undergoing treatment of bilateral cornual obstruction, the following results were obtained: post-operative patencies, 96; pregnancies, 48, of which 2 were ectopic; and reocclusions, 12. Of the reocclusions, 8 were treated with fluoroscopic catheterization of which two achieved normal pregnancies. The sole complication was a single cornual perforation with the tubal catheter. The results are statistically significant and indicate that the endoscopic treatment of bilateral tubal obstruction is effective.

Outcome of removal of intrauterine devices with flexible hysteroscopy in early pregnancy.

Removal of intrauterine devices (IUDs) in early pregnancy, when the IUDs threads are not visible at the cervical canal and the patient wishes to continue her pregnancy, remains a problem. Thirty-three patients using IUDs with nonvisible filaments on examination underwent flexible hysteroscopy for retrieval of the devices and follow-up until delivery. In all cases, hysteroscopies were performed without cervical dilatation and anesthesia. In 30 patients, the devices were found within the uterine cavity, and 28 IUDs were removed. In the remaining 3 patients, no IUD was observed. Twenty-four healthy children have been born. Six other patients requested a dilatation and curettage (D & C) about 1-2 weeks later after successful IUD removal. In 2 women, examinations were done at 22 and 29 weeks antepartum, and these 2 patients were lost to follow up. Operative fiberoptic hysteroscopy is proposed as a useful and effective method of retrieval of IUDs in early pregnancy when the filaments of the IUD are absent.