The impact of virtual reality technology in the era of See & Treat hysteroscopy: a randomised controlled trial

In the context of outpatient hysteroscopy (OPH), performing a single procedure integrating the operative and diagnostic part is known as "See & Treat hysteroscopy". The virtual reality (VR) technology provides an immersive virtual environment that can provide a non-invasive analgesic. To date, there is limited evidence regarding its use in the OPH setting.

To evaluate the feasibility and effectiveness of VR technology for pain and anxiety management in OPH.

Unblinded, prospective, randomised controlled trial, conducted at the Hysteroscopy Unit of the University of Naples "Federico II" between May and July 2024. Women aged 18-70 years, indicated for OPH, were randomised into a control group (standard OPH care) and an intervention group (OPH care with the addition of a VR headset).

Pain and anxiety were assessed through subjective measures: numerical rating scale (NRS) scores before and after the procedure, and objective measures: heart and respiratory rate pre- and during the procedure. Satisfaction, time, and success rates were also evaluated.

Overall, 116 women were enrolled. The VR group compared to the control group reported significantly lower mean standard deviation NRS scores for pain [3.9 (2.7) vs. 5.4 (3.0); mean difference 1.5, 95% confidence interval (CI) 0.4 to 2.5] and anxiety [3.2 (2.1) vs. 4.8 (2.8); mean difference 1.6, 95% CI 0.7 to 2.5] respectively. Regarding satisfaction, 96.5% of the VR group would use the headset again, whereas 3.5% requested its removal. All women in the control group desired a distraction. No serious adverse events were reported.

VR technology proved feasible and effective for pain and anxiety management in OPH, particularly during operative procedures.

Its use can support the implementation of the See & Treat philosophy.