Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases

J Minim Invasive Gynecol. Jan-Feb 2013;20(1):56-63. doi: 10.1016/j.jmig.2012.08.778. Epub 2012 Oct 27.

Abstract

Study objective: To determine the safety and satisfaction among patients undergoing operative hysteroscopy in an office-based setting.

Design: Retrospective analysis (Canadian Task Force classification II-2).

Setting: Physician's private office.

Patients: Women undergoing operative hysteroscopy in an office setting.

Interventions: Three hundred eighty-seven women underwent a total of 414 operative hysteroscopic procedures, with use of parenterally administered moderate sedation, a 9-mm operative resectoscope, and sonographic guidance. All patients were American Society of Anesthesiologists class I-III.

Measurements and main results: A total of 305 primary operative hysteroscopic procedures were performed including endomyometrial resection, myomectomy, polypectomy, removal of a uterine septum, and adhesiolysis. One hundred nine (26.3%) repeat operative procedures were performed in women in whom previous endometrial ablation and resection had failed. The average procedure required a mean (SD) of 37.6 (13.5) minutes to complete, and produced 14.1 (10.2) g of tissue. Ninety-nine percent of all procedures were completed. Only 1 patient required a hospital transfer for evaluation of a uterine perforation necessitating diagnostic laparoscopy. There were 8 (1.9%) postoperative infections, and no complications attributable to use of conscious sedation. Two hundred fifty-five women (65.6%) responded to our telephone survey. Two hundred fifty-two (98.8%) respondents were either "very satisfied" or "satisfied." Two hundred forty-nine women (97.6%) preferred the office to a hospital setting, whereas 6 (2.4%) would have preferred a hospital setting. All but 5 respondents would recommend this procedure to a friend.

Conclusion: Major operative hysteroscopic surgery can be performed in an office-based setting with a high degree of safety and patient satisfaction.

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures / economics
  • Ambulatory Surgical Procedures / standards*
  • Anesthetics / therapeutic use
  • Female
  • Humans
  • Hysteroscopy / economics
  • Hysteroscopy / methods*
  • Middle Aged
  • Patient Safety*
  • Patient Satisfaction*
  • Postoperative Complications*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Uterine Diseases / surgery*

Substances

  • Anesthetics