Developments in technology and the manufacturing of smaller diameter hysteroscopes have made it possible to carry out diagnostic and some operative hysteroscopic procedures in the outpatient setting without dilating the cervix or general anaesthesia in most cases.
Outpatient diagnostic hysteroscopy is an acceptable method for investigating women with abnormal uterine bleeding. It offers a high success rate (more than 95%), high rate of detection of pathology (more than 50%, depending on the indications) with a very low morbidity.
Uterine distension with normal saline allows better image quality and allows outpatient diagnostic hysteroscopy to be completed quicker than carbon dioxide. It also allows the use of a non-touch vaginoscopic approach which cause less pain.
Limitation of outpatient hysteroscopy
The failure rate of outpatient hysteroscopy is low, but difficulties may be encountered in:
- nulliparous women
- postmenopausal women
- cervical stenosis
- severe patient anxiety
- pre-existing pelvic pain
- extreme retroversion.
Advantages of outpatient hysteroscopy:
- general anaesthesia is not required - less time off work and less cost
- high level of patient acceptance and satisfaction
- it is an integral part of the investigations and management of women within a one stop menstrual clinic
- potential for performing some hysteroscopic procedures without the need to readmit the patient to hospital. For example:
- directed endometrial sampling
- endometrial polypectomy
- adhesiolysis (if minor)
- resection of some submucous fibroids (small diameter, type 0: 100% of the fibroid in the cavity)
- localisation and removal of a missed intrauterine IUCD
- endometrial ablation
- outpatient sterilisation.