Design: A retrospective observational analysis.
Setting: Hospital-affiliated gynecology clinic at a tertiary care safety-net hospital.
Patients or Participants: All patients who underwent office hysteroscopy in our gynecology clinic from September 2022 to February 2024.
Interventions: Tissue morcellator hysteroscopes and fluid management systems were obtained in clinic in September 2022. Patients with an indication for hysteroscopy underwent an in-clinic procedure. If intrauterine pathology was found, it could be resected during the same procedure whereas, prior to the intervention, these patients would have been referred to the OR for treatment. For analgesia, the majority of patients were given IM ketorolac and paracervical block with a lidocaine gel coated speculum. Some patients received IM morphine and PO diazepam depending on patient and provider preference.
Measurements and Main Results: In the eighteen months after implementation, a total of 457 patients were seen and consented for hysteroscopy with 430 undergoing a clinic hysteroscopy. Of the patients who underwent a hysteroscopy, 249 (57.9%) required use of a tissue morcellator for directed sampling or resection of a lesion, 421 (97.9%) tolerated the hysteroscopy with the analgesia provided, and 34 (7.9%) were referred for a repeat clinic hysteroscopy to complete resection of their pathology. Out of the patients seen in hysteroscopy clinic, 20 (4.4%) were referred to the OR for a hysteroscopy and 27 (5.9%) were referred to the OR for hysterectomy. The most common reasons that a procedure was not completed in the clinic were inability to obtain adequate distension (3.7%), intolerance to pelvic exam (2.6%), and pathology too large to resect in clinic (2.6%).
Conclusion: Office operative hysteroscopy is a well-tolerated and safe alternative to hysteroscopy in the OR. Offering see-and-treat hysteroscopy allowed the vast majority to avoid needing an additional procedure in the OR, thus decreasing OR utilization as well as patient appointment time commitment.