Four steps for successful office hysteroscopy

July 25, 2019

Anthony N. Imudia, MD, Erika P. New, MD, MPH

When selecting candidates for office hysteroscopy, individual patient self-assessment of pain tolerance and anxiety can help determine who would benefit most from an office-based procedure

When selecting candidates for office hysteroscopy, individual patient self-assessment of pain tolerance and anxiety can help determine who would benefit most from an office-based procedure as opposed to an operating room procedure.1 Determinants of successful office-based hysteroscopy for polyp removal are polyp number, size, and location; patient characteristics such as body mass index (BMI) and other comorbidities; availability of an appropriate hysteroscopic system; and physician experience and comfort level with the procedure.Â Related:Â Endometrial polyps: In-office management

References:

1. Ireland LD, Allen RH. Pain management for gynecologic procedures in the office. Obstet Gynecol Surv. 2016 Feb;71(2):89-98.

Step 1: Patient selection

Counsel and educate the patient about the planned procedure

Discuss the patient's perceived pain tolerance and anxiety about the procedure

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Step 2: Patient preparation

Administer NSAIDs such as ibuprofen 800 mg PO 1-hour pre-procedure

Administer low-dose vaginal misoprostol (50 mcg) the night prior to the procedure if operative hysteroscopy

Administer an anxiolytic (valium 5-10 mg) 1-hour prior to procedure if operative hysteroscopy

Step 3: Procedural techniques

Apply topical 20% benzocaine gel to the external cervical os with a cytology brush for further pain control

Use a tenaculum only if you are unable to enter the cavity

Ensure that the physician has adequate training and prior experience performing office hysteroscopy

Step 4: Hysteroscopy

For diagnostic hysteroscopy, a flexible hysteroscope is recommended

For operative hysteroscopy for polypectomy
small-caliber rigid hysteroscope (< 5 mm) is recommended to prevent cervical dilation

Adhere to Steps 2 and 3