Four year evaluation of therapeutic hysteroscopy under procedural sedation in an outpatient clinic

Cornelissen, Lisa G.H.; Kortekaas, Joep C.; Schoot, Benedictus C.; Vliet, Huib A.A.M. van

doi:10.1016/j.ejogrb.2021.04.002

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…To our knowledge, there are no other trials that report on outcomes of PSA for hysteroscopic myomectomy alone. The largest prospective cohort study on PSA with propofol for therapeutic hysteroscopic procedures was performed by Cornelissen and colleagues, who described the results of 455 hysteroscopic procedures [ 9 ]. In 3.3% of the patients, the procedure was incomplete, and in 6.2% of patients, a reintervention was needed.…”

Section: Discussionmentioning

confidence: 99%

“…For gynecologic procedures, less literature on the use of PSA is available. A prospective cohort that was recently published showed that the performance of several therapeutic hysteroscopic procedures—including hysteroscopic myomectomy—is safe and feasible when performed under PSA with propofol: Complication rate and incompleteness rates were low, and the majority of patients was satisfied with the procedure [ 9 ]. However, the amount of myomectomies in this cohort was low, and a randomized controlled trial (RCT) comparing hysteroscopic myomectomy under PSA with the same procedure under GA is lacking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy (PROSECCO trial): A multicenter randomized controlled trial

van der Meulen,

Bongers,

van der Zee

et al. 2023

PLoS Med

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Background Hysteroscopic resection is the first-choice treatment for symptomatic type 0 and 1 fibroids. Traditionally, this was performed under general anesthesia. Over the last decade, surgical procedures are increasingly being performed in an outpatient setting under procedural sedation and analgesia. However, studies evaluating safety and effectiveness of hysteroscopic myomectomy under procedural sedation are lacking. This study aims to investigate whether hysteroscopic myomectomy under procedural sedation and analgesia with propofol is noninferior to hysteroscopic myomectomy under general anesthesia. Methods and findings This was a multicenter, randomized controlled noninferiority trial conducted in 14 university and teaching hospitals in the Netherlands between 2016 and 2021. Inclusion criteria were age ≥18 years, maximum number of 3 type 0 or 1 fibroids, maximum fibroid diameter 3.5 cm, American Society of Anesthesiologists class 1 or 2, and having sufficient knowledge of the Dutch or English language. Women with clotting disorders or with severe anemia (Hb < 5.0 mmol/L) were excluded. Women were randomized using block randomization with variable block sizes of 2, 4, and 6, between hysteroscopic myomectomy under procedural sedation and analgesia (PSA) with propofol or under general anesthesia (GA). Primary outcome was the percentage of complete resections, assessed on transvaginal ultrasonography 6 weeks postoperatively by a sonographer blinded for the treatment arm and surgical outcome. Secondary outcomes were the surgeon’s judgment of completeness of procedure, menstrual blood loss, uterine fibroid related and general quality of life, pain, recovery, hospitalization, complications, and surgical reinterventions. Follow-up period was 1 year. The risk difference between both treatment arms was estimated, and a Farrington–Manning test was used to determine the p-value for noninferiority (noninferiority margin 7.5% of incomplete resections). Data were analyzed according to the intention-to-treat principle, including a per-protocol analysis for the primary outcome. A total of 209 women participated in the study and underwent hysteroscopic myomectomy with PSA (n = 106) or GA (n = 103). Mean age was 45.1 [SD 6.4] years in the PSA group versus 45.0 [7.7] years in the GA group. For 98/106 women in the PSA group and 89/103 women in the GA group, data were available for analysis of the primary outcome. Hysteroscopic resection was complete in 86/98 women (87.8%) in the PSA group and 79/89 women (88.8%) in the GA group (risk difference −1.01%; 95% confidence interval (CI) −10.36 to 8.34; noninferiority, P = 0.09). No serious anesthesiologic complications occurred, and conversion from PSA to GA was not required. During the follow-up period, 15 serious adverse events occurred (overnight admissions). All were unrelated to the intervention studied. Main limitations were the choice of primary outcome and the fact that our study proved to be underpowered. Conclusions Noninferiority of PSA for completeness of resection was not shown, though there were no significant differences in clinical outcomes and quality of life. In this study, hysteroscopic myomectomy for type 0 and 1 fibroids with PSA compared to GA was safe and led to shorter hospitalization. These results can be used for counseling patients by gynecologists and anesthesiologists. Based on these findings, we suggest that hysteroscopic myomectomies can be performed under PSA in an outpatient setting. Trial registration The study was registered prospectively in the Dutch Trial Register (NTR 5357; registration date: 11 August 2015; Date of initial participant enrollment: 18 February 2016).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy (PROSECCO trial): A multicenter randomized controlled trial

van der Meulen,

Bongers,

van der Zee

et al. 2023

PLoS Med

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“…Therefore, sedation significantly decreased patient discomfort and anxiety and increase the success rates of surgery. Cornelissen and colleagues reported the safety and feasibility of therapeutic hysteroscopy under procedural sedation in an outpatient setting, with a high patient satisfaction rate [14]. A 2021 systematic review revealed that sedation significantly reduced intraprocedural pain when compared to local anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Procedural sedation was a good alternative for patients with anxiety and expected painful procedures. Lisa and colleagues demonstrated the safety and feasibility of performing therapeutic hysteroscopies under procedural sedation in an outpatient setting, with low pain scores and a high level of patient satisfaction [14].…”

Section: Introductionmentioning

confidence: 99%

The Current Situation of Anaesthesia for Hysteroscopy in Mainland China: A National Survey

Huang,

Yu,

Zhu

et al. 2023

JPM

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Purpose: The need for anaesthesia or analgesia for performing hysteroscopy remains debatable. This study aimed to conduct an overview of the situation of anaesthesia for hysteroscopy in mainland China. Methods: Two questionnaires were separately designed for anaesthesiologists and gynaecologists and distributed to every medical institution that performed hysteroscopic procedures on patients with infertility in mainland China. Electronic questionnaires were distributed via WeChat, and data on anaesthesia regimen, monitoring parameters, procedure number, and other information were collected. Results: Reproductive technology is conducted by 536 institutions in mainland China. The survey received 491 responses from anaesthetists (91.6%) and 436 from gynaecologists (81.3%). In 2021, 552,225 hysteroscopies were conducted in 268 medical centres. The average percentage of hysteroscopy under anaesthesia is 63.8% in 2021, wherein 47.3% of institutions have an anaesthesia percentage of >75%. Propofol and opioid analgesics, such as fentanyl and sufentanil, were the most commonly used intravenous anaesthetics. All sedations were performed by anaesthesiologists. Monitoring parameters included pulse oxygen saturation (98.9%), electrocardiogram (91.6%) and noninvasive blood pressure (91.3%). An anaesthesiologist-to-operating room ratio of <1 was observed in 31.3% of medical institutions. Surprisingly, 52.4% of medical institutions performing hysteroscopy had no postanaesthesia care unit (PACU). Most institutions with PACU were equipped with independent oxygen sources, suction and monitors. Both rigid and flexible hysteroscopes (rigid hysteroscope, 45.1%; flexible hysteroscope, 4.5%; both types, 50.4%) were used, and the hysteroscopic diameter was ≤5 mm in 60.3% of medical centres. Conclusions: China performs a large number of hysteroscopies, and sedation is the most frequently used anesthesia regimen. However, issues such as inadequate emergency support devices, insufficient personnel and weak resuscitation management after anaesthesia, have been observed.

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“…Знеболювання з протитривожним ефектом є хорошою альтернативою для пацієнток із тривожністю та очікуванням болючих процедур [13]. LGH Cornelissen та співавтори (2021) продемонстрували доцільність виконання терапевтичних гістероскопій зі зниженням тривожності пацієнток в амбулаторних умовах, з низькими показниками болю та високим рівнем їхньої задоволеності [14][15][16].…”

Section: Inhalation Anesthesia With Methoxyflurane For Office Hystero...unclassified

Inhalation anesthesia with methoxyflurane for office hysteroscopy

Kotsabyn,

Boychuk,

Yakymchuk

et al. 2024

RHW

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Hysteroscopy is considered the “gold standard” for endoscopic visualization of the uterine cavity. Various methods of anesthesia and analgesia for the hysteroscopy procedure are described, including general anesthesia, sedation, local anesthesia, oral analgesics, and inhalation anesthesia.The objective: to assess the use of inhalation sedation with methoxyflurane during office hysteroscopy.Materials and methods. A prospective clinical study was performed in 109 patients during 2022-2024 who admitted to the reproductive health center “Damia” for the treatment of infertility. During office hysteroscopy, all patients had examination of the uterine cavity and biopsy of the endometrium with forceps.I group included 57 women who were prescribed rectal ketoprofen 100 mg and per os paracetamol 500 mg as analgesia during hysteroscopy in outpatient settings; II group involved 52 patients who received methoxyflurane for analgesia through an individual device for inhalation use.The Spielberger–Hanin scale was used to determine the levels of personal and reactive anxiety; assessment of psychoemotional status for the study of depressive disorders was carried out using the Beck depression scale and determination of the effectiveness of analgesic therapy. Statistical processing of the research results was performed using the program “STATISTICA 10”.Results. The spread of chronic endometritis, which was diagnosed for the first time, was established in more than half of the patients (56.9%). When using methoxyflurane for analgesia by the inhalation method, the examined patients subjectively assessed the pain at a rather low level (0.14±0.05 points), and the intensity of pain in the I group was significantly higher (0.41±0.08 points; p=0.005).In the postoperative period in the patients of the I group there were significantly higher levels of depressive disorders (7.84±0.86 points vs 4.54±0.62 points in the II group; p=0.002), personal (27.12±2.32 points vs 19.64±2.04 points; p=0.017) and situational (21.92±2.14 vs 15.56±1.72 points; p=0.022) anxiety, a reduced level of mood and emotionality, which differed from the indicators of women of the II group. Among the most frequent complaints in the I group, dyspeptic disorders (31.6%) and pain in the epigastric area (21.05%) were observed. When using methoxyflurane, the most frequent complaints were headache and drowsiness (11.5% each).Conclusions. The use of inhalation anesthesia with methoxyflurane during hysteroscopy allows to reduce negative pain sensations, anxiety and can be the optimal method for anesthesia for its performance in outpatient conditions.

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Four year evaluation of therapeutic hysteroscopy under procedural sedation in an outpatient clinic

Cited by 8 publications

References 28 publications

Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy (PROSECCO trial): A multicenter randomized controlled trial

Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy (PROSECCO trial): A multicenter randomized controlled trial

The Current Situation of Anaesthesia for Hysteroscopy in Mainland China: A National Survey

Inhalation anesthesia with methoxyflurane for office hysteroscopy

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