Imaging and diagnostic accuracy of outpatient and inpatient hysteroscopy

Aim. To compare the results of visualisation and diagnostic accuracy during outpatient and inpatient hysteroscopy in women with endometrial disease.Materials and Methods. We performed a retrospective analysis of patients with uterine diseases who underwent outpatient hysteroscopy at Kemerovo City Clinical Hospital №4 (n = 300) or inpatient hysteroscopy within the hospitals (n = 300) in Kemerovo from 2018 to 2020. Confirmation of endometrial disease was carried out by manual vacuum aspiration.Results. Indications, imaging, and diagnostic accuracy did not differ for most endometrial diseases in outpatient and inpatient hysteroscopy, yet inpatient hysteroscopy was the option of choice in women with infertility (p = 0.035). Diagnostic accuracy of outpatient and inpatient hysteroscopy was highly concordant, albeit outpatient hysteroscopy more often revealed adenomyosis and uterine malformation and less often identified endometrial polyps.Conclusion. Outpatient and inpatient hysteroscopy are equally efficient, although outpatient hysteroscopy has its benefits in detecting adenomyosis and uterine malformation and be less informative in diagnosing endometrial polyps.

Pseudo Vaginoscopy: A Modified Vaginoscopy Technique for Outpatient Hysteroscopy in Cases with Difficult Access

Background: Outpatient hysteroscopy is a safe, reliable and cost-effective alternative to hysteroscopy under a general anaesthetic for the diagnosis of abnormal uterine bleeding. Objectives: The objective of this study was to introduce new technique of pseudo-vaginoscopy for better movement of hysteroscope and less procedural pain. Also to assess acceptability of patients for outpatient hysteroscopy when appropriate analgesia was given prior to the procedure. Methodology: A prospective study was conducted of 74 women attending for outpatient hysteroscopy at the West Cumberland Hospital over a period of one year. Selection criteria include very narrow and atrophic vagina and failed speculum examination in gynaecology outpatient clinics. Results: Of the women studied, 95.5% stated that they would recommend the procedure to friends in future, whilst 5.8% would not want to go through it again. The type of anaesthetic administered during the procedure seem to influence whether women would attend for outpatient hysteroscopy in future. Conclusion: Our pseudo-vaginoscopic approach allows more freedom for the scope movements not limited by the speculum with the advantage of prior cervical preparation. It was certainly at value for operative outpatient hysteroscopy in patients with very high BMI where access was difficult owing to depth.

Advances in Outpatient Hysteroscopy

Hysteroscopy is a gynaecological procedure that has developed into an important tool to identify endometrial abnormality. It offers direct examination of the uterine cavity and tubal ostia and offers the option of performing targeted biopsy of suspected lesions that can be missed by blind procedures. In a large number of cases, the intrauterine lesions can be diagnosed and treated at the same setting as one step approach (“see and treat”). For example, endometrial polyps can be identified and removed; intrauterine adhesions may be divided in the office owing to the practicability of operative saline hysteroscopy, vaginoscopic approach and the convenience of miniature hysteroscopes. There is decent evidence that hysteroscopy in the outpatient clinic setting is preferred by the patients, associated with low risk of complications, quicker recovery time and reduced cost. Technological advances have led to development of high definition miniature hysteroscopes without negotiating optical performance, and hence making hysteroscopy an ingenuous, safe and trusted office procedure. Recent advances such as bipolar electrosurgery, endometrial ablation devices, morcellators and tissue retrieval system has transformed the surgical technique. This modernization of hysteroscopy completely revolutionised the approach to the management of intrauterine pathologies, moving from a blind procedure under general anaesthesia to directly visualised procedure under no or local anaesthesia, offering diagnostic as well as therapeutic procedures that should be at the disposal of every modern gynaecologist.

An audit on outpatient hysteroscopy – cervical dilatation, failure rates and patient satisfaction

Aims: To audit the use of cervical dilators, local anaesthetic, and failure rates in outpatient hysteroscopy over a two-year period in University Hospital Kerry. To review the experiences of women attending the outpatient hysteroscopy clinic (OHC) over a two-year period in University Hospital Kerry. Methods: Retrospective data review was carried out. Green-top Guideline No. 59: Best Practice in Outpatient Hysteroscopy, published by the Royal College of Obstetricians and Gynaecologists (RCOG), was the standard used for comparison. Results: Two hundred and twenty women were seen over a two-year period. The average age was forty-eight. The most common complaint being of menorrhagia/irregular bleeding per vaginum (PV). Local anaesthetic was used in just under one third of cases of which half required cervical dilatation. Most women reported experiencing mild to moderate levels of discomfort however most would opt for an outpatient hysteroscopic procedure again if required. Discussion/Conclusion: Outpatient hysteroscopy is a well-tolerated and safe procedure. Suitability for outpatient hysteroscopy is not predictable based on parity of menopausal status. Women would elect to undergo outpatient hysteroscopy again if required and this is likely due to several reasons including convenience and lack of requirement for general anaesthetic.