Operative office hysteroscopy without anesthesia

Literature Review Article

Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. Bettocchi S, Ceci O, Nappi L, DiVenere R, Masciopinto V, Pansini V, Pinto L, Santoro A, Cormio G. Journal of the American Association of Gynecologic Laparoscopists 2004;11(1):59-61. 

Review
Michelle L. Matthews, M.D. 

The purpose of this retrospective case review was to evaluate the efficacy of office hysteroscopy without anesthesia as well as patient satisfaction using 5F hysteroscopic instruments for treatment of benign intrauterine lesions. Patients ranged in age from 17-81 years and were treated in the proliferative phase of the cycle. A 5 mm hysteroscope with 5F scissors and grasping forceps were used without a tenaculum or speculum and saline was used for distention. Of the 4863 patients, preoperative intrauterine lesions included endometrial polyps (996), cervical polyps (2306), stenosis (1450), and adhesions (771). Polyps ranged in size from 0.2 mm to 3.7 cm. 

Over 90% of patients reported no discomfort during hysteroscopy for synechiae or for cervical or endometrial polyps, unless the polyps were larger than the internal cervical os (63.6% reported low or moderate pain). Pain was related to difficulties removing the polyp from the cavity, traction, numerous passages of the hysteroscope and maneuvers required to grasp the polyp. For patients with stenosis, 12.7% reported moderate pain. 

Histologic exam corresponded to the hysteroscopic diagnosis in all but 3 cases and follow-up 3 months after surgery showed a 5.6% recurrence rate of pathology. The authors conclude that simple instruments enable performance of many operative hysteroscopic procedures in the office setting with excellent patient satisfaction, provided that correct indications are observed. 

Comments 
Meike L. Uhler, M.D.
Steven R. Lindheim, M.D.
 

This article represents an extensive experience in operative office hysteroscopy. Clearly, there is a group of patients who benefit from this procedure, alleviating the need for outpatient hospitalization and its corresponding costs. No complications were noted but infection was not specifically cited.

It would have been interesting to note whether ultrasound guidance would have helped with any of the procedures, particularly in those patients with larger intrauterine lesions. It has recently been suggested that many gynecologic procedures may benefit from the use of real-time ultrasonography to decrease in both operative time and complication rates, although the evaluation and assessment of the value of intraoperative ultrasound in gynecology is essentially non-existent (1). 

References: 

  1. Criniti A, Lin PC. Applications of intraoperative ultrasound in gynecological surgery. Curr Opin Obstet Gynecol. 2005 Aug;17(4):339-342.

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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