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Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases
Ettore Cicinelli1, Carlo Parisi, Pietro Galantino
1First Department of Obstetrics and Gynecology, University of Bari, Bari, Italy. cicinelli@gynecology1.uniba.it
Objective:
To assess the reliability, feasibility, and safety of lens-based minihysteroscopy.
Design:
Retrospective comparative study.
Setting:
Academic research environment.
Patient(S):
Women with different indications for hysteroscopy.
Intervention(S):
Six thousand seventeen outpatient diagnostic hysteroscopies with a minihysteroscope (2.7-mm outer diameter [OD] telescope with 3.5-mm OD single-flow diagnostic sheath) and 4,204 with traditional hysteroscope (4-mm OD telescope with 5-mm OD single-flow diagnostic sheath). All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus.
Main Outcome Measure(S):
Rate of successful introduction of the hysteroscope, rate of satisfactory examinations, pain intensity experienced using an arbitrary pain scale (0 = no pain; 1 = low pain; 2 = moderate pain; 3 = severe pain), and number of side effects and complications.
Result(S):
In the minihysteroscopy, group rates of successful introduction and satisfactory examinations were significantly higher than in the traditional hysteroscope group (99.52% vs.72.53% and 98.53% vs. 92.33%, respectively), while pain and vagal reactions were significantly lower (0.10 +/- 0.34 vs.1.09 +/- 0.53 and 2.25% vs.17.12%, respectively).
Conclusion(S):
Hysteroscopy with lens-based minihysteroscopes was easier, less painful, more reliable, and safer than with 5-mm hysteroscopes. Minihysteroscopy with a vaginoscopic approach is a very well tolerated, effective, and safe outpatient procedure.