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Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies. | LitMetric

Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies.

Fertil Steril

Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, United Kingdom.

Published: February 2008

AI Article Synopsis

  • The study aimed to explore how operator experience influences the success of outpatient hysteroscopy and to assess whether using normal saline, narrow-caliber hysteroscopes, and a vaginoscopic approach lowers failure rates.
  • Conducted at a teaching hospital, this retrospective study involved 5,000 women undergoing hysteroscopies from 1988 to 2003, comparing outcomes based on operator experience and different techniques used.
  • Results showed a high success rate of around 95%, with failure and complication rates of 5.2% and 5.4%, respectively, indicating that factors like postmenopausal status and technique used significantly impacted success rather than solely operator experience.

Article Abstract

Objective: 1) To investigate the relationship between operator experience and the success of outpatient hysteroscopy; and 2) to determine if the introduction of normal saline and the use of narrow-caliber hysteroscopes and vaginoscopic approach are associated with a lower failure rate.

Design: Retrospective study.

Setting: Teaching-hospital based outpatient hysteroscopy clinic.

Patient(s): Five thousand consecutive women undergoing outpatient hysteroscopy between October 1988 and June 2003.

Intervention(s): The hysteroscopies were carried out both by experienced operators and by trainees. Procedures were performed using 4-mm and 2.9-mm telescopes with 5-mm and 3.5-mm diagnostic sheaths, respectively. Between October 1988 and 1996, the uterine cavity was distended with CO(2) (CO(2) period), whereas normal saline was preferred after 1997 (1997-2003: saline period). Traditional technique of hysteroscope insertion and vaginoscopic approach were used depending on operator preference and experience and patient characteristics.

Main Outcome Measure(s): Success, failure, and complication rates.

Result(s): The hysteroscopies were successfully performed in nearly 95% of cases by 362 operators (mean 13.8 hysteroscopies per operator) with different levels of expertise. Failure and complication rates were 5.2% and 5.4%, respectively, without any significant difference between CO(2) and saline periods. Vasovagal attacks and shoulder pain were significantly higher during the CO(2) period. The success of outpatient hysteroscopy was negatively affected by postmenopausal status, nulliparity, need for cervical dilatation or local anaesthesia, traditional technique of hysteroscope insertion, and use of a 5-mm hysteroscope.

Conclusion(s): A high level of expertise is not a prerequisite to performing hysteroscopy on an outpatient basis. Recent advances in technique and instrumentation facilitate this approach and might encourage greater adoption by the wider gynecology community.

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Source
http://dx.doi.org/10.1016/j.fertnstert.2007.02.056DOI Listing

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