International Consensus Statement for Recommended Terminology Describing Hysteroscopic Procedures

Abstract

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Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

“…In 2021, an international working group of experts in hysteroscopy from the AAGL, the European Society for Gynaecological Endoscopy, and the Global Community of Hysteroscopy released a consensus statement outlining standardized terminology to describe multiple aspects of hysteroscopic procedures. 12 The authors proposed a hierarchical nomenclature to report pain-control measures for hysteroscopy across five levels. Level 1 indicates no medications or use of oral nonsedating medications only, level 2 involves administration of local anesthetic agents to the genital tract, level 3 describes conscious sedation (with level 3a connoting oral or inhaled medications and level 3b parenteral medications), level 4 signifies regional anesthesia, and level 5 indicates general anesthesia.…”

“…Level 1 indicates no medications or use of oral nonsedating medications only, level 2 involves administration of local anesthetic agents to the genital tract, level 3 describes conscious sedation (with level 3a connoting oral or inhaled medications and level 3b parenteral medications), level 4 signifies regional anesthesia, and level 5 indicates general anesthesia. 12 The group further outlined consistent terminology whereby the term office hysteroscopy refers to procedures performed in settings where pain management up to level 3a can be safely administered. Office hysteroscopy may be used interchangeably with outpatient clinic hysteroscopy in the United States and requires that patients arrive and leave a medical facility on the same calendar day.…”

“…Office hysteroscopy may be used interchangeably with outpatient clinic hysteroscopy in the United States and requires that patients arrive and leave a medical facility on the same calendar day. 12 Importantly, office hysteroscopy can include both diagnostic and operative procedures, which can be distinguished by whether the procedure confers direct therapeutic benefit.…”

Endometrial polypectomy using tissue removal device or electrosurgical snare: a randomised controlled trial

“…Hysteroscopy was performed either in the outpatient clinic or in the operating room under sedation, depending on the woman's preference. Level 1 of pain management was used in outpatient care (Carugno et al, 2021). No specific sedative medication was recommended prior to the procedure in the outpatient clinic.…”

Opinion paper: gynecological surgery in local anesthesia?

“…In this context, the paracervical block (PCB) enables performing operations in which a pain stimulus is applied in the area of the cervix uteri without the need for general anesthesia. According to the “Consensus Statement for Recommended Terminology Describing Hysteroscopic Procedures” of the International Working Group of the American Association of Gynecologic Laparoscopists (AAGL), the European Society for Gynaecological Endoscopy (ESGE) and the Global Community of Hysteroscopy (GCH) this stands for a level 4 of pain management [ 7 ]. Known complications of general anesthesia such as postoperative nausea and vomiting (PONV) or postoperative cognitive dysfunction (POCD) in elderly patients can be avoided.…”