Feasibility of Office-based Operative Hysteroscopy by a Tissue Removal System without Anesthesia

Matan Mor; Maayan G Kochav; Jodi Ezratty; Maya N Dovev; Neta Eisenberg; Noam Smorgick

doi:10.1016/j.jmig.2024.05.005

Feasibility of Office-based Operative Hysteroscopy by a Tissue Removal System without Anesthesia

J Minim Invasive Gynecol. 2024 May 11:S1553-4650(24)00207-3. doi: 10.1016/j.jmig.2024.05.005. Online ahead of print.

Authors

Matan Mor¹, Maayan G Kochav¹, Jodi Ezratty¹, Maya N Dovev¹, Neta Eisenberg¹, Noam Smorgick²

Affiliations

¹ Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel. Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors).
² Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel. Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors).. Electronic address: noam_yossi@yahoo.com.

PMID: 38740128
DOI: 10.1016/j.jmig.2024.05.005

Abstract

Study objective: To investigate the feasibility of operative hysteroscopy by a hysteroscopic tissue removal system (HTRS) without anesthesia in women with endometrial polyps (EP) or retained products of conception (RPOC).

Design: Prospective observational cohort study.

Setting: University-affiliated Department of Obstetrics and Gynecology.

Patients: Consenting women aged >18 years diagnosed with EP or RPOC from 9/2022 to 8/2023 confirmed by a prior office hysteroscopy.

Interventions: Office-based vaginoscopic operative hysteroscopy without anesthesia using the Mini-Elite Truclear HTRS. Oral misoprostol was prescribed for cervical ripening. The patients rated intraoperative and 5-minute postoperative pain levels on a visual analog scale, with mild pain defined as a score of 0 to 4, moderate as 5 to 7, and severe as 8 to 10. A successful procedure was defined as complete removal of the pathology.

Measurements and main results: Fifty patients were included in this pilot study, and 47 (94.0%) procedures were completed successfully, including 21/24 (87.5%) cases of EP and all cases of RPOC (26/26, p = .06). No intra- or postoperative complications occurred. The intraoperative pain levels were rated as mild, moderate, and severe by 26 (52.0%), 16 (32.0%) and 8 (16.0%) patients, respectively. Severe intraoperative pain was more common in nulliparous women and those >10 years from their last vaginal delivery and was not associated with patient age, menopausal status, presence of abnormal uterine bleeding, or pathology size. Severe postoperative pain, reported by 5 (10.0%) patients, was significantly associated with removal of EP compared with RPOC, longer operative time, and nulliparity or >10 years from the last vaginal delivery. The procedure was considered acceptable by 46 (92.0%) patients, and 45 (90.0%) would recommend it to a friend/relative.

Conclusions: Office-based operative hysteroscopy by the HTRS is successful and well tolerated by most women, especially for RPOC removal.

Keywords: Endometrial polyp; Hysteroscopic tissue removal system; Hysteroscopy; Retained products of conception; Vaginoscopy.