OUR EXPERIENCE IN

OUTPATIENT OPERATIVE HYSTEROSCOPY

Corina Vasile, Giuseppe Sacco

Dept. Gynaecology ObstetricsMirano (Venice) Hospital- ITALY

OUT PATIENT OPERATIVE HYSTEROSCOPY

Nowadays the development of new small caliber instruments and techniques determined an

increased patients compliance

during outpatient hysteroscopic procedures

Bettocchi S Operative Office hysteroscopy without anaesthesia: analysis of 4863 cases performed with mechanical instruments J Am Assoc Gynecol Laparosc, 2004Marsh F A randomised controlled trial comparing outpatientversus daycase endometrial polypectomy , BJOG, 2006Litta P Outpatient operative polypectomy using a 5 mm hysteroscope without anesthesia and/or analgesia: advantages and limits Eur J Obstet Gynecol&Reprod Biol, 2008Di Spiezio Sardo A, Taylor A et al Hysteroscopy: a technique for all?Analysis of 5000 outpatient hysteroscopies Fertil Steril 2008

OFFICE OPERATIVE HYSTEROSCOPY

NO TOUCH TECHNIQUE

Operative double flow Minihysteroscopes

Bipolar minielectrodsMechanical mininstruments

OUR EXPERIENCE - MATERIALS

Between September 2009 and September 2011

142 patients underwentoperative outpatient hysteroscopic

procedures

median age 46 yrs (23-74)

Without anaesthesiologic support in an outpatient setting

Pain level was determined using an analogic score from 0 to 10

OUR EXPERIENCE - METHODS

Instruments

● 30 grade Hopkins II rod lens 2.9 mm telescope● 5 mm continuous flow office Hysteroscope (Bettocchi Office Hysteroscope size 5; Karl Storz GmbH & Co., Tuttlingen, Germany).● 5 Fr. working channel● 1.6 mm diameter mechanical forceps and grasper● Bipolar non disposable electrodes coaxial and curved ( Karl Storz GmbH & Co. Tuttlingen, Germany)

● Saline distension medium●Endomat pump – medium pressure 60 mm Hg●Vaginoscopic no touch technique● Essure inserts by Conceptus Inc/ Cremascoli Iris●Image data archive Cremascoli Iris srl Milanopatients were monitored for 1 hour after the procedure

OUR EXPERIENCE - RESULTS

PolipectomyEssureOUI adhesiolysisEndometrial focal resection

Polypectomy 80 cases

Essure30 cases

Focal endometrialresection/ target biopsy24 cases

Adhesiolysis8 cases

OUR EXPERIENCE - RESULTS

● Mean operative time – 14 min (range 5-19 min)● Mean pain score – 3 (range 0-6)● No complications occurred● Out of 80 - 75 polypectomies were performed in outpatient setting feasibility 93% - mean diameter 1.5 cm (range 0.5 -3 cm)● The duration of the procedure correlated with polyp size● All 30 Essure sterilizations were successful – control after 3 months revealed normal positioned devices with complete tubal occlusion obtained

● Pain is a determining factor for patients compliance in outpatient hysteroscopy● The duration of the procedure must not exceed 15 minutes● Polyps size correlates with duration of the procedure therefore with pain●An attentive patients selection, the use of adequate miniinstruments and a good level of hysteroscopic “no touch” technique are mandatory in order to perform quick, painless and safe procedures● Patients satisfaction with outpatient hysteroscopy is high● Outpatient operative hysteroscopy is feasible and may substantially reduce the number of inpatient, operating room procedures reducing hospital costs

CONCLUSIONS