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Objective To assess the failure rate of diagnostic outpatient hysteroscopy using a 2.5‐mm semirigid hysteroscope. Design Retrospective cohort analysis. Setting Outpatient hysteroscopy unit in a large district general hospital. Sample All patients who had a diagnostic outpatient hysteroscopy during the study period. Main outcome measures Hysteroscopy was considered a failure when the uterine cavity was not accessible or when the view obtained was unsatisfactory. Results A total of 1976 patients were seen in the direct‐access hysteroscopy unit between November 1994 and May 1999. The procedure was performed successfully in 1898 patients (96.1%) but failed in 78 patients (3.9%). Causes for failure included: cervical stenosis (n = 54; 67.9%), severe discomfort (n = 7; 8.9%), unsatisfactory view (n = 6; 2.6%), obesity (n = 5; 6.4%), large cervical polyp (n = 4; 5.1%) and vagal reaction (n = 2; 2.6%). Overall failure was more likely in postmenopausal (46/894; 5.1%) than in premenopausal patients (32/1082; 2.9%). Conclusions Diagnostic outpatient hysteroscopy using a 2.5‐mm semirigid hysteroscope is a simple, safe, effective and acceptable investigation. The most common reason for a failed outpatient microhysteroscopy was cervical stenosis particularly in postmenopausal women.

Objective To avoid vascular and visceral injury in a patient undergoing laparoscopic adhesiolysis and known to have extensive intra‐abdominal adhesions. Design An optical Veress needle was used to establish pneumoperitoneum under direct vision through Palmer's point. Safe sites were identified for the insertion of the secondary trocars. Result Satisfactory laparoscopic adhesiolysis was performed without any complications. Conclusion Microlaparoscopy using an optical Veress needle inserted through Palmer's point seems to be a safe technique for avoiding laparoscopic injury when extensive adhesions are suspected.

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This retrospective observational study was carried out in a large district general hospital to review the outcome of outpatient micro-hysteroscopy performed on women with abnormal bleeding while on hormone replacement therapy. All women referred to the outpatient hysteroscopy unit with abnormal bleeding while on hormone replacement therapy between November 1994 and August 1998 had hysteroscopy performed using a 1.2 mm semi-rigid hysteroscope with a 2.5 mm sheath. Hysteroscopy was performed on 190 women. Ninety-two women (48.4%) had a normal uterine cavity, 38 (20%) had an atrophic endometrium, 52 (27.4%) were found to have endometrial polyps, seven (3.7%) had suspicious endometrium (histology showed two adenocarcinomas and three hyperplasias) and one patient (0.5%) had a submucous fibroid. Histological evaluation showed 145 (76.32%) specimens were benign, 37 (19.47%) specimens either contained no tissue or insufficient tissue for diagnosis, five (2.63%) showed hyperplasia and three (1.58%) were adenocarcinoma. Two hyperplasias and one focal adenocarcinoma were diagnosed in endometrial polyps. Nearly half of the women who had a hysteroscopy for abnormal bleeding while on hormone replacement therapy had a normal endometrial cavity. Almost one-third had endometrial pathology, of which the majority were endometrial polyps. The incidence of endometrial carcinoma was low. No abnormality was missed on hysteroscopy, but histology was normal in two patients with hysteroscopically suspicious endometrium.