Ambulatory hysteroscopy

Abstract

Key content Routine diagnostic hysteroscopy under general anaesthesia is an anachronism. Evidence‐based RCOG guidance should be followed to ensure best practice in outpatient hysteroscopy. The role of hysteroscopy in the diagnostic work‐up of abnormal bleeding and reproduction remains unclear and further research is required to elucidate where it can be used most cost‐effectively. Learning objectives A ‘no touch’ vaginoscopic technique should be employed routinely as this approach reduces pain during diagnostic rigid outpatient hysteroscopy and facilitates operative procedures by improving manipulation of miniature endoscopic equipment. A contemporary outpatient hysteroscopy service should be able to provide surgical treatments for uterine polyps, small fibroids, lost coils, minor uterine anomalies, menstrual disorders and permanent contraception. Ethical issues Can we justify subjecting women, especially those with significant medical co‐morbidities, to the risks and inconvenience of general anaesthesia for hysteroscopic procedures?

Twelve-Month Outcomes for Patients Undergoing Hysteroscopic Morcellation of Uterine Polyps and Myomas in an Office or Ambulatory Surgical Center

“…Currently, most hysteroscopic procedures occur in hospital-based settings and relatively few procedures occur in an office setting [11][12][13]. Several studies have shown the feasibility of performing hysteroscopic procedures in office settings, although none of these studies examined morcellation [14][15][16][17].…”

Fibroids and Hysteroscopy: An Overview

“…U.S]; tissue retrieval systems: TRUCLEAR ™ [Smith & Nephew Inc., Andover, MA, UH. USA], MyoSure® [Hologic, Marlborough, MA, USA] have led to a paradigm shift in surgical interventions leading to procedures that were performed under general anesthesia being conducted in an outpatient setting with local anesthesia only and if necessary [14,33].…”

“…There are many benefits to performing hysteroscopy in an outpatient setting, provided it is done safely and effectively, compared to hysteroscopy in the operating room: it does not require hospital admission, preoperative testing, or general or local anesthesia; it decreases post-surgical recovery times and overall procedure costs and it improves procedure satisfaction level for both healthcare providers and patients [11][12][13][14][15].…”

Acceptability of Endometrial Polyp Resection under Local Anaesthesia

“…This also has the added advantage of treating the patient at the time of diagnosis with many clinical and nonclinical benefits such as possibility of obtaining targeted tissue biopsies, avoidance of risk of general anaesthesia, low procedure related cost, less hospital appointments, least time away from home and quicker return to work (9,10,11,12,13) . However, the patient's acceptability and feasibility is not well understood (14) . This study aims to assess the patient's acceptability in a secondary care setting in the United Kingdom.…”