Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy

Literature Review Article

Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy. Campo R, Molinas C, Rombauts L, Mestdagh G, Lauwers M, Braekmans P, Brosens I, VanBelle Y, Gordts S. Human Reproduction 2004;20(1):258-263. 

Review
Michelle L. Matthews, M.D. 

This is the first randomized controlled trial to compare the performance of office conventional hysteroscopy versus mini-hysteroscopy while evaluating the effects of patient parity and surgeon's experience. Patients were assigned to conventional hysteroscopy with a 5 mm rigid hysteroscope (n=240) or mini-hysteroscopy (n=240) with a semirigid hysteroscope set (2.7 and 3.5 mm hysteroscopes). The experimental design included a total of 8 groups and allowed evaluation of the effects of instrument diameter, patient parity and surgeon's experience. Patients were blinded to the assignment. Anesthesia, cervical dilation, or other intrauterine interventions were not allowed. 

Mini-hysteroscopy was associated with less pain, improved visualization of the uterine cavity, and higher success rates (all statistically significant). The complication rates were similar (1.3-3.3%) and were all vasovagal reactions with no uterine perforations reported. A better performance with conventional hysteroscopy was observed in patients with prior vaginal deliveries and in procedures performed by experienced surgeons. However, both patient parity and surgeon's experience were no longer significant with mini-hysteroscopy. The conclusions of this study are that mini-hysteroscopy has potential as a first line office diagnostic procedure as it may overcome the difficulties determined by anatomy and surgeon experience and is associated with minimal patient discomfort, excellent visualization and few complications.

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

This investigation brings to the forefront mini-hysteroscopy for the office setting (1). A smaller diameter hysteroscope with satisfactory visualization of the uterine cavity offers many advantages to the patient and surgeon. As more practioners gain experience with smaller hysteroscopes, more procedures can be done in the office setting obviating the need for outpatient surgery. Proper selection criteria are essential to identify the ideal patient who can undergo an office-based procedure.

References: 

  1. Isaacson K. Office hysteroscopy: a valuable but under-utilized technique. Curr Opinion Obstet Gynecol 2002: 14: 381-5.

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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