As technology improves, most of the gynaecological surgical procedures can be done on an outpatient basis safely.
This article looks at the indications and benefits of outpatient hysteroscopy. The Royal College of Obstetricians and Gynaecologists (UK) recommends that every hospital should have an outpatient hysteroscopy service. This should be separate from a main theatre service and have a separate facility.
Outpatient hysteroscopy is an established diagnostic test which involves the use of miniaturized endoscopic equipment to directly visualize and examine the uterine cavity. There is no need for formal theatre facilities, general or regional anaesthesia.
It can be done in your gynaecologist’s office with minimal or no discomfort and this results in more than 85 per cent of hysteroscopies being done on an outpatient basis.
Outpatient hysteroscopy can either be diagnostic or operative.
Diagnostic indications for out-patient hysteroscopy include irregular bleeding over 45 years of age, an ultrasound scan which shows polyps (thickening of the lining of the womb), intermenstrual bleeding for more than 6 months, post-menopausal bleeding, ultrasound findings which are equivocal and heavy menstrual bleeding and during investigations for infertility.
Operative indications include the removal of an IUCD, endometrial biopsy(direct), before and after endometrial ablation, polypectomy, and the removal of fibroids division of uterine adhesions.
Most polyps can be removed with a grasping forceps or scissors or a combination of both or with the use of bipolar cutting instruments.
The ability to have tissue morcellators like Myosure have made resection of sub-mucosal fibroids (fibroids on the inside of the uterus) and polyps possible as an outpatient and is very effective.
The benefits which are numerous for having and outpatient hysteroscopy service include:
1. Cost savings, there is no need for sterilization of equipment and no significant capital costs for the initial purchase of equipment
2. Quicker recovery as no general anaesthetic is used.
3. Minimal analgesia as only non-steroidal analgesia is used
4. Minimal time off from work
5. No theatre cost
6. No large amount of staff
7. Cost savings for the patient
Contraindications for this procedure include:
1. Unable to pass or extreme discomfort when passing a speculum
2. An inability to lie flat
3. Very large BMI as may be technically difficult
In conclusion, outpatient hysteroscopy has several benefits in the diagnosis of bleeding disorders and can be used surgically to resect and biopsy lesions in the uterus safely. It avoids the use of a general anaesthetic which has been the norm and it is found to be extremely cost-effective. These cost savings can then be passed onto the patient.
Article is done by Dr John Barker Bsc MBBS MRCOG BSCCP(cert), Dip (Risk Management). Consultant Obstetrician/Gynaecologist at JRB Medical Centre, 7th Avenue Belleville.
His special interests include Gynaecological Oncology, Emergency Gynaecology, Alternatives to Hysterectomy, Out-patient Hysteroscopy, High Risk Obstetrics.