OUR EXPERIENCE IN OUTPATIENT OPERATIVE HYSTEROSCOPY

1. OUR EXPERIENCE IN OUTPATIENT OPERATIVE HYSTEROSCOPY CorinaVasile, Giuseppe Sacco Dept. Gynaecology Obstetrics Mirano (Venice) Hospital- ITALY

2. OUT PATIENT OPERATIVE HYSTEROSCOPY Nowadays the development of new small caliber instruments and techniques determined an increased patients compliance during outpatient hysteroscopic procedures

3. Bettocchi SOperative Office hysteroscopy without anaesthesia: analysis of 4863 cases performed with mechanical instruments J Am Assoc Gynecol Laparosc, 2004 Marsh FA randomised controlled trial comparing outpatient versus daycase endometrial polypectomy , BJOG, 2006 Litta POutpatient operative polypectomy using a 5 mm hysteroscope without anesthesia and/or analgesia: advantages and limits Eur J Obstet Gynecol&Reprod Biol, 2008 Di Spiezio SardoA, Taylor A et alHysteroscopy: a technique for all?Analysis of 5000 outpatient hysteroscopies Fertil Steril 2008

4. Operative double flow Minihysteroscopes NO TOUCH TECHNIQUE OFFICE OPERATIVE HYSTEROSCOPY Bipolar minielectrods Mechanical mininstruments

5. OUR EXPERIENCE - MATERIALS Between September 2009 and September 2011 142 patients underwent operative 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

6. 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) • Salinedistension 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 Milano patients were monitored for 1 hour after the procedure

7. OUR EXPERIENCE - RESULTS Focal endometrial resection/ target biopsy 24 cases Adhesiolysis 8 cases Polypectomy 80 cases Essure 30 cases

8. 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

9. CONCLUSIONS • 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