Objective: Evaluation of the viability of office hysteroscopy in an Indian context at a single center. To encourage budding gynecologists to perform office hysteroscopy, which is possible with successful results with the correct strategy, method, and setting.
Methods: Observational analysis in retrospect. Between January 2011 and January 2022, 4827 women had office hysteroscopy at our center. Around 1627 instances of office hysteroscopy with a Bettocchi 2.9 scope and a Hamou endomat were performed from 2011 to 2022 and 3200 hysteroscopies with Bettocchi 1.9 scope and Endometrial automatic suction irrigation system (EASI) (2011–2022). The distension media utilized was regular saline. Hamou endomat parameters included a 200 ml/min drip rate, a 75-mm Hg irrigation pressure, and a 0.15 suction bar. Bettocchi 4 (1.9 mm) and Bettocchi 5 (2.9 mm) scope settings with EASI were 45 mm Hg. An experienced operator with office hysteroscopy training performed the hysteroscopy. Every operation was performed during the early proliferative period (4th–11th day). Key outcome measurements were complications, success and failure rates.
Results: In roughly 4821 of instances, hysteroscopies were successful; however, 35 patients had pathology that required a two-step treatment. The majority of the hysteroscopies (2470; 51.2%) were diagnostic ones, while the remaining (2357; 48.83 %) were surgical ones. A vasovagal attack affected just two patients (2 of 4827).
Conclusion: Together with reduced pressure, continuous flow irrigation, and vaginoscopic technique, advising the patient for ambulatory hysteroscopy played a crucial role in the outpatient environment in helping the patient deal with discomfort and anxiety. This method is made easier by recent developments in technique and apparatus, which may stimulate a wider acceptance by the gynecological community.
Di Spiezio A, Calagna SG, Di Carlo C. Tips and tricks in office hysteroscopy. Gynecol Minim Invasive Ther 2015;4(1):3–7. DOI: 10.1016/j.gmit.2014.12.004.
Cooper NA, Smith P, Khan KS, et al. Vaginoscopic approach to outpatient hysteroscopy: A systematic review of the effect on pain. BJOG 2010;117(5):532–539. DOI: 10.1111/j.1471-0528.2010.02503.x.
Cooper NAM, Clark TJ. Ambulatory hysteroscopy. Obstet Gynaecol 2013;15(3):159–166. DOI: 10.1111/tog.12039.
Di SpiezioSardo A, Taylor A, Tsirkas P, et al. Hysteroscopy: A technique for all? Analysis of 5,000 outpatient hysteroscopies. Fertil Steril 2008;89(2):438–443. DOI: 10.1016/j.fertnstert.2007.02.056.
Bettocchi S, Ceci O, Di Venere R, et al. Advanced operative office hysteroscopy without anaesthesia: Analysis of 501 cases treated with a 5 Fr bipolar electrode. Hum Reprod 2002;17(9):2435–2438. DOI: 10.1093/humrep/17.9.2435.
Bettocchi S, Ceci O, Napp L, et al. Operative office hysteroscopy without anesthesia: Analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc 2004;11(1): 59–61. DOI: 10.1016/S1074-3804(05)60012-6.
Tangri MK, Lele P, Kapur K, et al. Role of office hysteroscopy in gynecology: Retrospective observational study at a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol 2017;6(1):111–116. DOI: 10.18203/2320-1770.ijrcog20164642.
Di SpiezioSardo A, Mazzon I, Bramante S, et al. Hysteroscopic myomectomy: A comprehensive review of surgical techniques. Hum Reprod Update 2008;14(2):101–119. DOI: 10.1093/humupd/dmm041.
Shih CL, Hung YC, Chen CP, et al. Resectoscopic excision of the vaginal septum in a virgin with uterus didelphys and obstructed unilateral vagina. Taiwan J Obstet Gynecol 2010;49(1):109–111. DOI: 10.1016/S1028-4559(10)60022-8.
Tasma ML, Louwerse M, Hehenkamp WJ, et al. Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multicentre randomised placebo controlled trial. BJOG 2018;125(1):81–89. DOI: 10.1111/1471-0528.14567.
Prabhakaran S, Chuang A. In office retrieval of intrauterine contraceptive devices with missing strings. Contraception 2011;83(2):102–106. DOI: 10.1016/j.contraception.2010.07.004.
Marsh F, Kremer C, Duffy S. Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy. BJOG 2004;111(3):243–248. DOI: 10.1111/j.1471-0528.2004.00064.x.
Di Spiezio SA, Marialuigia S, Brunella Z, et al. Ambulatory management of heavy menstrual bleeding. Women's Health 2016;12(1):35–43. DOI: 10.2217/whe.15.80.
Agostini A, Bretelle F, Ronda I, et al. Risk of vasovagal syndrome during outpatient hysteroscopy. J Am Assoc Gynecol Laparosc 2004;11(2): 245–247. DOI: 10.1016/S1074-3804(05)60207-1.
Cooper NAM, Khan KS, Clark TJ. Local anaesthesia for pain control during outpatient hysteroscopy: Systematic review and meta-analysis. BMJ 2010;340(c1130):1–9. DOI: 10.1136/bmj.c1130.
Angelis CD, Santoro G, Re ME. Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial. Hum Reprod 2003;18(11):2441–2445. DOI: 10.1093/humrep/deg463.