The Experts below are selected from a list of 23013 Experts worldwide ranked by ideXlab platform
Adam Magos - One of the best experts on this subject based on the ideXlab platform.
-
Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies
Fertility and sterility, 2007Co-Authors: Attilio Di Spiezio Sardo, Malini Sharma, George Mastrogamvrakis, Alexander Taylor, Panos Tsirkas, Adam MagosAbstract: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.
-
outpatient Hysteroscopy traditional versus the no touch technique
Obstetrical & Gynecological Survey, 2005Co-Authors: Malini Sharma, Alex H. Taylor, A. Di Spiezio Sardo, Lucie Buck, George Mastrogamvrakis, Ioannis P. Kosmas, Panagiotis Tsirkas, Adam MagosAbstract:All women who attended an outpatient Hysteroscopy clinic over a 12-month period were asked to participate in a prospective, randomized, controlled trial comparing pain levels associated with the "no-touch" technique or the traditional technique of performing Hysteroscopy. One hundred twenty patients met the eligibility requirements and agreed to participate. They were randomized to undergo Hysteroscopy with either the traditional or the no-touch technique (60 each). In addition, each group was further randomized to either a 2.9-mm or a 4.00-mm hysteroscope (30 each). In the no-touch group, 10 women required local anesthesia and/or cervical dilatation-2 in the 2.9-mm hysteroscope subgroup and 8 in the 4-mm subgroup. These women were converted to the traditional technique and Hysteroscopy was successfully completed. Data were then analyzed on an intent-to-treat classification. The traditional technique followed the standard pattern of speculum insertion, use of Littlewood's tenaculum to hold the cervix, dilation of the cervix if needed, and Hysteroscopy. A Pipelle de Cornier sampler was used to perform endometrial biopsy if required. In the no-touch technique, the hysteroscope was placed in the vagina with no speculum and then, with saline irrigant flowing, carefully inserted into the uterus through the cervical os without grasping. When an endometrial biopsy was necessary, Littlewood's tenaculum was used to hold the cervix. If cervical dilatation or intracervical local anesthesia was required, the procedure was converted to a traditional technique. Patient assessment of each technique was made immediately after Hysteroscopy and included pain scores for several phases of the procedure. Patients were also asked if they would recommend the technique to a friend, if they would ask for general anesthesia for a future procedure, and if they found the procedure acceptable. Only one Hysteroscopy, in which bleeding prevented hysteroscopic assessment, was considered not to be successful. More time was required to perform the traditional technique than the no-touch technique (7.8 minutes vs 5.9 minutes). Cervical dilatation was needed in 15 patients in the traditional group and 10 in the no-touch group. Local anesthesia was required in 13 and 11 patients in each group, respectively. One of the patients in the no-touch group received local anesthesia for the biopsy only and was not converted. Biopsies were taken in 42 patients in the traditional group and 40 patients in the no-touch group. The only statistically significant difference in pain scores was a greater perception of pain with biopsy in the no-touch group than in the traditional group. Otherwise, there were no differences in pain scores associated with insertion of the hysteroscope, hysteroscope inspection, placement of the speculum, local anesthetic, end of procedure, or 30 minutes after the end of Hysteroscopy. The highest scores were reported by women who were converted from the no-touch to the traditional technique for the pain from injections for local anesthesia. Overall, 92% of women found the outpatient Hysteroscopy experience very or fairly acceptable. Ninety-three percent would recommend it to a friend. Fifteen percent of women whose hysteroscope was 2.9 mm said they would ask for general anesthesia for any future hysteroscopies compared with 27% of women who were randomized to the 4.0-mm hysteroscope.
-
Outpatient Hysteroscopy: traditional versus the ‘no‐touch’ technique
BJOG : an international journal of obstetrics and gynaecology, 2005Co-Authors: Malini Sharma, Alex H. Taylor, A. Di Spiezio Sardo, Lucie Buck, George Mastrogamvrakis, Ioannis P. Kosmas, Panagiotis Tsirkas, Adam MagosAbstract:Objective To assess whether outpatient Hysteroscopy using the ‘no-touch’ technique confers any advantages in terms of patient discomfort over the traditional technique. Design Prospective randomised controlled study. Setting Outpatient Hysteroscopy clinic in a large university undergraduate teaching hospital. Population All women referred for outpatient Hysteroscopy in a 12-month period. Interventions Women were randomised to undergo either traditional saline Hysteroscopy requiring the use of a speculum and tenaculum, or a ‘no-touch’ vaginoscopic Hysteroscopy which does not require a speculum or tenaculum. Each group was further subdivided to have Hysteroscopy with either a 2.9-mm or 4-mm hysteroscope. Patients were asked to complete pre- and postprocedure questionnaires ranking pain scores. Main outcome measures The relative success of each of these techniques, requirement for local anaesthetic and pain scores at different times during the Hysteroscopy were recorded at the end of the procedure. The time taken to carry out each procedure was also measured. Results One hundred and twenty women were recruited in this study: 60 were randomised to traditional Hysteroscopy and 60 to ‘no-touch’ Hysteroscopy. The overall success rate for Hysteroscopy was 99%. There was no significant difference in the requirement for local anaesthetic between the two groups, but those who underwent ‘no-touch’ Hysteroscopy with a 2.9-mm hysteroscope had the lowest requirement of local anaesthetic (10% compared with 27% in the no-touch Hysteroscopy with a 4-mm hysteroscope group). The time taken to perform Hysteroscopy and biopsy was significantly shorter with ‘no-touch’ Hysteroscopy (5.9 vs 7.8 min; difference 1.9, 95% CI 0.7–3.1). There were no differences in pain scores between the groups at different times during Hysteroscopy. Conclusions ‘No-touch’ or vaginoscopic Hysteroscopy is significantly faster to perform than the traditional technique. Although there was no difference in pain scores between the two techniques, local anaesthetic requirements were least in those who underwent ‘no-touch’ Hysteroscopy with a narrow bore hysteroscope.
Malini Sharma - One of the best experts on this subject based on the ideXlab platform.
-
Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies
Fertility and sterility, 2007Co-Authors: Attilio Di Spiezio Sardo, Malini Sharma, George Mastrogamvrakis, Alexander Taylor, Panos Tsirkas, Adam MagosAbstract: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.
-
outpatient Hysteroscopy traditional versus the no touch technique
Obstetrical & Gynecological Survey, 2005Co-Authors: Malini Sharma, Alex H. Taylor, A. Di Spiezio Sardo, Lucie Buck, George Mastrogamvrakis, Ioannis P. Kosmas, Panagiotis Tsirkas, Adam MagosAbstract:All women who attended an outpatient Hysteroscopy clinic over a 12-month period were asked to participate in a prospective, randomized, controlled trial comparing pain levels associated with the "no-touch" technique or the traditional technique of performing Hysteroscopy. One hundred twenty patients met the eligibility requirements and agreed to participate. They were randomized to undergo Hysteroscopy with either the traditional or the no-touch technique (60 each). In addition, each group was further randomized to either a 2.9-mm or a 4.00-mm hysteroscope (30 each). In the no-touch group, 10 women required local anesthesia and/or cervical dilatation-2 in the 2.9-mm hysteroscope subgroup and 8 in the 4-mm subgroup. These women were converted to the traditional technique and Hysteroscopy was successfully completed. Data were then analyzed on an intent-to-treat classification. The traditional technique followed the standard pattern of speculum insertion, use of Littlewood's tenaculum to hold the cervix, dilation of the cervix if needed, and Hysteroscopy. A Pipelle de Cornier sampler was used to perform endometrial biopsy if required. In the no-touch technique, the hysteroscope was placed in the vagina with no speculum and then, with saline irrigant flowing, carefully inserted into the uterus through the cervical os without grasping. When an endometrial biopsy was necessary, Littlewood's tenaculum was used to hold the cervix. If cervical dilatation or intracervical local anesthesia was required, the procedure was converted to a traditional technique. Patient assessment of each technique was made immediately after Hysteroscopy and included pain scores for several phases of the procedure. Patients were also asked if they would recommend the technique to a friend, if they would ask for general anesthesia for a future procedure, and if they found the procedure acceptable. Only one Hysteroscopy, in which bleeding prevented hysteroscopic assessment, was considered not to be successful. More time was required to perform the traditional technique than the no-touch technique (7.8 minutes vs 5.9 minutes). Cervical dilatation was needed in 15 patients in the traditional group and 10 in the no-touch group. Local anesthesia was required in 13 and 11 patients in each group, respectively. One of the patients in the no-touch group received local anesthesia for the biopsy only and was not converted. Biopsies were taken in 42 patients in the traditional group and 40 patients in the no-touch group. The only statistically significant difference in pain scores was a greater perception of pain with biopsy in the no-touch group than in the traditional group. Otherwise, there were no differences in pain scores associated with insertion of the hysteroscope, hysteroscope inspection, placement of the speculum, local anesthetic, end of procedure, or 30 minutes after the end of Hysteroscopy. The highest scores were reported by women who were converted from the no-touch to the traditional technique for the pain from injections for local anesthesia. Overall, 92% of women found the outpatient Hysteroscopy experience very or fairly acceptable. Ninety-three percent would recommend it to a friend. Fifteen percent of women whose hysteroscope was 2.9 mm said they would ask for general anesthesia for any future hysteroscopies compared with 27% of women who were randomized to the 4.0-mm hysteroscope.
-
Outpatient Hysteroscopy: traditional versus the ‘no‐touch’ technique
BJOG : an international journal of obstetrics and gynaecology, 2005Co-Authors: Malini Sharma, Alex H. Taylor, A. Di Spiezio Sardo, Lucie Buck, George Mastrogamvrakis, Ioannis P. Kosmas, Panagiotis Tsirkas, Adam MagosAbstract:Objective To assess whether outpatient Hysteroscopy using the ‘no-touch’ technique confers any advantages in terms of patient discomfort over the traditional technique. Design Prospective randomised controlled study. Setting Outpatient Hysteroscopy clinic in a large university undergraduate teaching hospital. Population All women referred for outpatient Hysteroscopy in a 12-month period. Interventions Women were randomised to undergo either traditional saline Hysteroscopy requiring the use of a speculum and tenaculum, or a ‘no-touch’ vaginoscopic Hysteroscopy which does not require a speculum or tenaculum. Each group was further subdivided to have Hysteroscopy with either a 2.9-mm or 4-mm hysteroscope. Patients were asked to complete pre- and postprocedure questionnaires ranking pain scores. Main outcome measures The relative success of each of these techniques, requirement for local anaesthetic and pain scores at different times during the Hysteroscopy were recorded at the end of the procedure. The time taken to carry out each procedure was also measured. Results One hundred and twenty women were recruited in this study: 60 were randomised to traditional Hysteroscopy and 60 to ‘no-touch’ Hysteroscopy. The overall success rate for Hysteroscopy was 99%. There was no significant difference in the requirement for local anaesthetic between the two groups, but those who underwent ‘no-touch’ Hysteroscopy with a 2.9-mm hysteroscope had the lowest requirement of local anaesthetic (10% compared with 27% in the no-touch Hysteroscopy with a 4-mm hysteroscope group). The time taken to perform Hysteroscopy and biopsy was significantly shorter with ‘no-touch’ Hysteroscopy (5.9 vs 7.8 min; difference 1.9, 95% CI 0.7–3.1). There were no differences in pain scores between the groups at different times during Hysteroscopy. Conclusions ‘No-touch’ or vaginoscopic Hysteroscopy is significantly faster to perform than the traditional technique. Although there was no difference in pain scores between the two techniques, local anaesthetic requirements were least in those who underwent ‘no-touch’ Hysteroscopy with a narrow bore hysteroscope.
D Dewitt - One of the best experts on this subject based on the ideXlab platform.
-
Diagnostic Hysteroscopy.
American family physician, 1992Co-Authors: B S Apgar, D DewittAbstract:The hysteroscope is a valuable tool for selective viewing of the uterine cavity and the endocervical canal. With smaller-diameter scopes, Hysteroscopy can be performed in the office setting, often without the need for cervical dilatation or local anesthesia. Controlled-rate CO2 insufflators allow safe distention of the uterine cavity with minimal side effects. Indications for office Hysteroscopy include the evaluation of abnormal uterine bleeding, genital carcinoma and infertility and the investigation of a "lost" intrauterine device. Hysteroscopy is an adjunct to endometrial sampling, dilatation and curettage, hysterosalpingography and cervical cytology.
Fritz Nagele - One of the best experts on this subject based on the ideXlab platform.
-
Hysteroscopy in 2001: a comprehensive review.
Acta obstetricia et gynecologica Scandinavica, 2001Co-Authors: Fritz Wieser, Christine Kurz, Clemens B. Tempfer, Fritz NageleAbstract:Keywords: diagnostic Hysteroscopy; endometrial ablation; hysteroscopic metroplasty; hysteroscopic myomectomy; outpatient Hysteroscopy
-
Flexible versus rigid endoscopes for outpatient Hysteroscopy: a prospective randomized clinical trial
Human Reproduction, 2001Co-Authors: Gertrud Unfried, Alexander Albrecht, Fritz Wieser, Alexandra Kaider, Fritz NageleAbstract:To evaluate patient acceptance, optical properties and the clinical feasibility of flexible compared with rigid hysteroscopes, 142 patients undergoing outpatient Hysteroscopy were included in a prospective, randomized clinical trial. The flexible hysteroscope was used in 70 patients, and the rigid instrument in 72. At different stages of the Hysteroscopy the level of pain experienced by the women was assessed using a 10 cm visual analogue scale. Optical properties characterized by the parameters intrauterine visibility, hysteroscopic view and diagnostic accuracy were ranked by the surgeons using a 5-point scale (1 = excellent to 5 = insufficient), and duration of the Hysteroscopy was measured. Hysteroscopy was successful in 87.5 and 100% of patients in the flexible and rigid groups respectively. With the use of rigid telescopes, discomfort at introduction and during the Hysteroscopy was significantly greater (median 1.7 versus 0.7, P = 0.003; 3.1 versus 1.2, P < 0.001 respectively), but optical properties were judged to be far superior (P < 0.001 for all three comparisons) and procedure time was significantly shorter (median 70 versus 120 s, P = 0.003). In conclusion, outpatient Hysteroscopy seems to be less painful when using flexible telescopes. However, rigid hysteroscopes provide superior optical qualities and permit a more rapid performance with higher success rates at much lower cost.
-
Atraumatic Cervical Passage At Outpatient Hysteroscopy
Fertility and sterility, 1998Co-Authors: Fritz Wieser, Alexander Albrecht, Christine Kurz, René Wenzl, Johannes C Huber, Fritz NageleAbstract:Abstract Objective: To evaluate the efficacy of topical anesthesia routinely administered to reduce discomfort and the need for additional local anesthesia during outpatient Hysteroscopy. Design: Comparative observational study. Setting: Outpatient Hysteroscopy clinic in a University hospital. Patient(s): Three hundred patients undergoing outpatient Hysteroscopy. Intervention(s): Application of lidocaine spray both to the surface of the cervix and into the cervical canal before performing Hysteroscopy. Main Outcome Measure(s): The discomfort during passage of the hysteroscope through the cervical canal, the need for additional local anesthesia, and the failure rate of outpatient Hysteroscopy. Result(s): One hundred fifty consecutive patients receiving lidocaine spray before the Hysteroscopy were compared to a control group of another 150 consecutive patients who underwent the examination without pretreatment. Women treated with spray experienced significantly less pain at insertion of the hysteroscope. Furthermore, the spray significantly reduced both the need for additional anesthesia and the rate of failed hysteroscopies due to intolerable pain. Conclusion(s): Topical anesthesia with lidocaine spray is a simple method to alleviate patients' discomfort during cervical passage. It is effective in reducing the need for local anesthesia and should reduce the rate of failed outpatient hysteroscopies.
-
Ultrasonography, Hysteroscopy or both?
Journal of Obstetrics and Gynaecology, 1996Co-Authors: Ahmed Badawy, Fritz Nagele, A. Ash, Hossam Mohamed, Hugh O'connor, A. MagosAbstract:SummaryUltrasonography and Hysteroscopy are widely used in investigation of abnormal uterine bleeding, but there is much debate about their relative merits. To determine whether ultrasonography alone, Hysteroscopy alone, or both are necessary for making optimum management decisions we studied the records of 100 randomly selected patients presenting with various forms of abnormal uterine bleeding. Management based on ultrasonography or Hysteroscopy alone agreed in 45·5 to 75 per cent of patients depending on age and symptomatology. Ultrasound correctly predicted planned management in 9·5 to 33·3 per cent of cases which were missed by Hysteroscopy alone, while Hysteroscopy identified 7·1 to 30 per cent of suggested treatments not forecast after ultrasound alone. Compared with the results of both investigations, management based solely on ultrasound scanning or Hysteroscopy disagreed with 7·1 to 36·4 per cent and 12·5 to 33·3 per cent of treatment plans respectively depending on patient age and symptoms. Our...
George Mastrogamvrakis - One of the best experts on this subject based on the ideXlab platform.
-
Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies
Fertility and sterility, 2007Co-Authors: Attilio Di Spiezio Sardo, Malini Sharma, George Mastrogamvrakis, Alexander Taylor, Panos Tsirkas, Adam MagosAbstract: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.
-
outpatient Hysteroscopy traditional versus the no touch technique
Obstetrical & Gynecological Survey, 2005Co-Authors: Malini Sharma, Alex H. Taylor, A. Di Spiezio Sardo, Lucie Buck, George Mastrogamvrakis, Ioannis P. Kosmas, Panagiotis Tsirkas, Adam MagosAbstract:All women who attended an outpatient Hysteroscopy clinic over a 12-month period were asked to participate in a prospective, randomized, controlled trial comparing pain levels associated with the "no-touch" technique or the traditional technique of performing Hysteroscopy. One hundred twenty patients met the eligibility requirements and agreed to participate. They were randomized to undergo Hysteroscopy with either the traditional or the no-touch technique (60 each). In addition, each group was further randomized to either a 2.9-mm or a 4.00-mm hysteroscope (30 each). In the no-touch group, 10 women required local anesthesia and/or cervical dilatation-2 in the 2.9-mm hysteroscope subgroup and 8 in the 4-mm subgroup. These women were converted to the traditional technique and Hysteroscopy was successfully completed. Data were then analyzed on an intent-to-treat classification. The traditional technique followed the standard pattern of speculum insertion, use of Littlewood's tenaculum to hold the cervix, dilation of the cervix if needed, and Hysteroscopy. A Pipelle de Cornier sampler was used to perform endometrial biopsy if required. In the no-touch technique, the hysteroscope was placed in the vagina with no speculum and then, with saline irrigant flowing, carefully inserted into the uterus through the cervical os without grasping. When an endometrial biopsy was necessary, Littlewood's tenaculum was used to hold the cervix. If cervical dilatation or intracervical local anesthesia was required, the procedure was converted to a traditional technique. Patient assessment of each technique was made immediately after Hysteroscopy and included pain scores for several phases of the procedure. Patients were also asked if they would recommend the technique to a friend, if they would ask for general anesthesia for a future procedure, and if they found the procedure acceptable. Only one Hysteroscopy, in which bleeding prevented hysteroscopic assessment, was considered not to be successful. More time was required to perform the traditional technique than the no-touch technique (7.8 minutes vs 5.9 minutes). Cervical dilatation was needed in 15 patients in the traditional group and 10 in the no-touch group. Local anesthesia was required in 13 and 11 patients in each group, respectively. One of the patients in the no-touch group received local anesthesia for the biopsy only and was not converted. Biopsies were taken in 42 patients in the traditional group and 40 patients in the no-touch group. The only statistically significant difference in pain scores was a greater perception of pain with biopsy in the no-touch group than in the traditional group. Otherwise, there were no differences in pain scores associated with insertion of the hysteroscope, hysteroscope inspection, placement of the speculum, local anesthetic, end of procedure, or 30 minutes after the end of Hysteroscopy. The highest scores were reported by women who were converted from the no-touch to the traditional technique for the pain from injections for local anesthesia. Overall, 92% of women found the outpatient Hysteroscopy experience very or fairly acceptable. Ninety-three percent would recommend it to a friend. Fifteen percent of women whose hysteroscope was 2.9 mm said they would ask for general anesthesia for any future hysteroscopies compared with 27% of women who were randomized to the 4.0-mm hysteroscope.
-
Outpatient Hysteroscopy: traditional versus the ‘no‐touch’ technique
BJOG : an international journal of obstetrics and gynaecology, 2005Co-Authors: Malini Sharma, Alex H. Taylor, A. Di Spiezio Sardo, Lucie Buck, George Mastrogamvrakis, Ioannis P. Kosmas, Panagiotis Tsirkas, Adam MagosAbstract:Objective To assess whether outpatient Hysteroscopy using the ‘no-touch’ technique confers any advantages in terms of patient discomfort over the traditional technique. Design Prospective randomised controlled study. Setting Outpatient Hysteroscopy clinic in a large university undergraduate teaching hospital. Population All women referred for outpatient Hysteroscopy in a 12-month period. Interventions Women were randomised to undergo either traditional saline Hysteroscopy requiring the use of a speculum and tenaculum, or a ‘no-touch’ vaginoscopic Hysteroscopy which does not require a speculum or tenaculum. Each group was further subdivided to have Hysteroscopy with either a 2.9-mm or 4-mm hysteroscope. Patients were asked to complete pre- and postprocedure questionnaires ranking pain scores. Main outcome measures The relative success of each of these techniques, requirement for local anaesthetic and pain scores at different times during the Hysteroscopy were recorded at the end of the procedure. The time taken to carry out each procedure was also measured. Results One hundred and twenty women were recruited in this study: 60 were randomised to traditional Hysteroscopy and 60 to ‘no-touch’ Hysteroscopy. The overall success rate for Hysteroscopy was 99%. There was no significant difference in the requirement for local anaesthetic between the two groups, but those who underwent ‘no-touch’ Hysteroscopy with a 2.9-mm hysteroscope had the lowest requirement of local anaesthetic (10% compared with 27% in the no-touch Hysteroscopy with a 4-mm hysteroscope group). The time taken to perform Hysteroscopy and biopsy was significantly shorter with ‘no-touch’ Hysteroscopy (5.9 vs 7.8 min; difference 1.9, 95% CI 0.7–3.1). There were no differences in pain scores between the groups at different times during Hysteroscopy. Conclusions ‘No-touch’ or vaginoscopic Hysteroscopy is significantly faster to perform than the traditional technique. Although there was no difference in pain scores between the two techniques, local anaesthetic requirements were least in those who underwent ‘no-touch’ Hysteroscopy with a narrow bore hysteroscope.