Office hysteroscopy: A scientific overview

Office hysteroscopy, when defined as the vaginoscopic procedure, is a method which can be performed with very little discomfort for the patient and at an extremely low risk for serious complications. It has a low failure rate and high efficacy. It can be used for routine diagnostics but also for small operational interven tions and diagnosis of malignancy and pre-malignancy. It has proved to be superior to other diagnostic tools in the unique possibility of visualization and simultaneous visually-controlled biopsy. Primarily and foremost however, it represents an enormously beneficial gain in both time and psychological impact for the patients undergoing the procedure, who often obtain immediate diagnosis and treatment. There is a further advantage in minimizing the diameter of the hysteroscope, the so-called mini-hysteroscope of 3.3 mm sheath diameter being significantly better tolerated than the wider 4 mm hysteroscope. The use of mini-hysteroscopes may also obviate the need to restrict the patient population to those having undergone vaginal delivery or the need for a very experienced surgeon. At present, however, there seems to be no clear advantage in using a flexible scope, as the gain of greater patient comfort is outweighed by the fact of greater visibility, shorter procedure time and thus lower cost of rigid hysteroscopy. Given that this procedure is still more expensive, more time-consuming and somewhat less comfortable for patients than routine ultrasound it may at this time be premature to recommend, as suggested by some authors [29, 14], it as a screening tool for asymptomatic patients. Most asymptomatic patients will after all present to the clinic without uterine abnormality or cause for intervention. © 2011 Termedia Sp. z o.o. All rights reserved.