Operative hysteroscopy in the office setting.

STUDY OBJECTIVE: To describe the feasibility of operative hysteroscopy in the office setting. DESIGN. Descriptive study (Canadian Task Force classification II-2).

SETTING: University-based private practice.

PATIENTS: Women undergoing assisted reproduction in whom diagnostic evaluation revealed uterine cavity pathology.

INTERVENTION: Patients were offered office hysteroscopy and allowed to choose between paracervical block anesthesia supplemented with mild intravenous sedation or full conscious sedation, administered by an anesthesiologist. A MicroSpan Hysteroscopy system or HysteroSys Flexible Hysteroscope system was used for diagnostic purposes. When pathology was identified, resection was performed with 2-mm operative instruments or a VersaPoint hysteroscopic electrosurgical electrode using bipolar coagulation through an expandable operating channel.

MEASUREMENTS AND MAIN RESULTS: Of 69 women with abnormal sonohysterographic and hysterosalpingogram studies, 44 agreed to office hysteroscopy. Thirty-three (48%) underwent VersaPoint resection and/or scissors resection, which was successfully accomplished in 32 (97%). Significant cervical stenosis in one woman precluded resection because of concern of creating a false passage. Concomitant diagnostic laparoscopy and operative hysteroscopy was performed in one patient. Average operating and anesthesia times were 45.2 +/- 20.3 minutes and 67.2 +/- 28.4 minutes, respectively. One uterine perforation occurred (3.3%) during resection of intrauterine adhesions.

CONCLUSION: Office hysteroscopy is a time-efficient and cost-effective procedure, made possible by the development of small instruments. Proper patient selection and training of office personnel are mandatory to minimize complications and maximize efficacy.