The safety and tolerability of Bettocchi operative hysteroscopy in a women’s health clinic
Background. The most important issues are the level of painful sensations and safety during office hysteroscopy without anesthesia.Klyucharov I.V., Morozov V.V., Gaineeva Z.A., Klivlend G.O., Ustinova E.M.
Objective. To comparatively assess the level of painful sensations and the nature and number of complications during Bettocchi operative hysteroscopy.
Subjects and methods. Operative hysteroscopy was performed in 370 patients. The visual analogue scale (VAS) was used to assess pain. Complications were recorded if they occurred.
Results. To change a hysteroscopic procedure from traditional to contactless could significantly decrease painful sensations that accounted for diagnostic and operational Me 1 (1.2; 1.7) and Me 3 (2.3; 3.1) (p < 0.0001) in the polypectomy group, Me 1 (0.8; 1.5) and Me 3 (2.2; 3.9) (p < 0.0001) in the myomectomy group, Me 1 (0.84; 2.9) and Me 4 (2.9; 4.8) (p = 0.007) in the synechiolysis group, Me 1 (1.3; 1.7) and Me 3 (2.7; 3.3) (p < 0.0001) in the entire group, respectively. The difference in the level of painful sensations between the same stages in different groups was insignificant (p> 0.05). Complications as vasovagal reactions associated with 370 hysteroscopies were observed in 4 (1.08%) cases.
Conclusion. The investigation has demonstrated the tolerability of both diagnostic and surgical stages and the high safety profile of office hysteroscopy.
Keywords
office hysteroscopy
antenatal clinic
visual analogue scale
pain assessment
complications
Supplementary Materials
- Table 1. Comparative analysis of patients’ characteristics and pain levels utilizing VAS during standard and “touchless” hysteroscopy
- Table 2. Inter-group variability of VAS numbers (Wilkinson Method, SPSS Statistics)
- Table 3. Between the group variability analysis of VAS (Mann-Whitney Method, SPSS Statistics)
References
1. Wortman M. Instituting an office-based surgery program in the gynecologist’s office. J. Minim. Invasive Gynecol. 2010; 17(6): 673-83.
2. Palter S.F. Microlaparoscopy under local anesthesia and conscious pain mapping for the diagnosis and management of pelvic pain. Curr. Opin. Obstet. Gynecol. 1999; 11(4): 387-93.
3. Kira E.F., Permyakov A.S., Gamirova E.B. The outlook of outpatient surgery through the prism of the pelvic floor. Zhurnal akusherstva i zhenskih bolezney. 2009; 58(5): 32-3. (in Russian)
4. Bezhinashvili E.V., Svinarev M.Yu. Experience in the use of office hysteroscopy for the diagnosis of abnormal bleeding in puberty in girls. Reproduktivnoe zdorove detey i podrostkov. 2016; 2: 48-9. (in Russian)
5. Zaydieva Ya.Z. Abnormal uterine bleeding against the background of menopausal hormone therapy. Almanah klinicheskoy meditsinyi. 2015; 3: 100-4. (in Russian)
6. Popov A.A., Machanskite O.V., Golovina E.N. Office hysteroscopy and infertility. Zhurnal akusherstva i zhenskih bolezney. 2011; 60(4): 87-90. (in Russian)
7. Popov A.A., Machanskite O.V., Golovina E.N., Manannikova T.N., Ramazanov M.R., Fedorov A.A., Krasnopolskaya I.V., Slobodyanyuk B.A. Office hysteroscopy as a stage of preparation for the use of in vitro fertilization programs. Rossiyskiy vestnik akushera-ginekologa. 2011; 11(3): 52-4. (in Russian)
8. Isaacson K. Office hysteroscopy: a valuable but under-utilized technique. Curr. Opin. Obstet. Gynecol. 2002; 14(4): 381-5.[
9. Klyucharov I.V., Shulaev A.V., Gayfullin R.F., Timershin R.R. On the development of hysteroscopic technologies. Prakticheskaya meditsina. 2016; 2(4): 52-5. (in Russian)
10. Valle R.F., Sciarra J.J. Hysteroscopy: a useful diagnostic adjunct in gynecology. Am. J. Obstet. Gynecol. 1975; 122(2): 230-5.
11. Valle R.F. Hysteroscopy for gynecologic diagnosis. Clin. Obstet. Gynecol. 1983; 26(2): 253-76.
12. Kulakov V.I., Adamyan L.V., Myinbaev O.A. Principles of organizing the work of a gynecological clinic of a surgical profile. In: Kulakov V.I., Adamyan L.V. Endoscopy in gynecology. A guide for doctors. Moscow: Meditsina; 2000: 48-54. (in Russian)
13. Zullo F., Pellicano M., Stigliano C.M., Di Carlo C., Fabrizio A., Nappi C. Topical anesthesia for office hysteroscopy. A prospective, randomized study comparing two modalities. J. Reprod. Med. 1999; 44(10): 865-9.
14. Saveleva G.M., Breusenko V.G., Kappusheva L.M. Hysteroscopy. Atlas and guideline. Moscow: GEOTAR-Media; 2014. (in Russian)
15. Bettocchi S, Selvaggi L. A vaginoscopic approach to reduce the pain of office hysteroscopy. J. Am. Assoc. Gynecol. Laparosc. 1997; 4(2): 255-8.
16. Bettocchi S., Ceci O., Nappi L., Di Venere R., Masciopinto V., Pansini V., Pinto L., Santoro A., Cormio G. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J. Am. Assoc. Gynecol. Laparosc. 2004; 11(1): 59-61.
17. Bettocchi S., Ceci O., Di Venere R., Pansini M.V., Pellegrino A., Marello F. et al. Advanced operative office hysteroscopy without anesthesia: analysis of 501 cases treated with a 5 Fr bipolar electrode. Hum. Reprod. 2002; 17(9): 2435-8.
18. Soloveva E.A., Konstantinova O.D., Trishina M.A., Muzyichenko O.V. Experience in organizing surgical care in outpatient settings for women with reproductive system diseases. Uralskiy meditsinskiy zhurnal. 2015; 5: 59-63. (in Russian)
19. American College of Obstetricians and Gynecologists. Committee on Practice Bulletins-Gynecology. Committee Opinion No. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet. Gynecol. 2012; 120(1): 197-206.
20. Moawad N.S., Santamaria E., Johnson M., Shuster J. Cost-effectiveness of office hysteroscopy for abnormal uterine bleeding. JSLS. 2014; 18(3): pii: e2014.00393. doi: 10.4293/JSLS.2014.00393.
21. European Society of Gynecologic Endoscopy, Hysteroscopy Standards. Available at: http://www.esge.org/education/endoscopic-training/esge-hysteroscopy-standard (in Russian)
Received 08.11.2016
Accepted 11.11.2016
About the Authors
Klyucharov Igor Valerievich, Ph.D., Associate Professor of the Department of Obstetrics and Gynecology No. 1, Kazan State Medical University, Ministry of Health of Russia, doctor-consultant of the women’s consultation of the Medical Sanitary Unit, Kazan Federal University.420012, Russia, Kazan, Butlerova str. 49. Tel.: +79172824474. E-mail: klyucharoff@yandex.ru. Orcid.org/0000-0002-2895-3722
Morozov Vadim V., M.D., FACOG, FACS, Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School
Of Medicine. Medical Director, Paca-Redwood OB/GYN Faculty Physicians, Inc. Program Director, Center of Excellence in Minimally Invasive Gynecology (COEMIG)
at UMMC. 11 South Paca Street 4th floor, Baltimore MD 21201, USA. Tel.: +1-410-328-5964. E-mail: vmorozov@fpi.umaryland.edu
Gaineeva Zaytuna Askarovna, Head of Women’s Consultation of the Medical Sanitary Unit, Kazan Federal University.
420012, Russia, Kazan, Dostoevskogo str. 44/6. Tel.: +78432362171. E-mail: Elenadoc64@gmail.com
Klivlend Gulnara Olegovna, post-graduate student of the Department of Obstetrics and Gynecology No. 1, Kazan State Medical University, Ministry of Health of Russia, doctor-consultant of the women’s consultation of the Medical Sanitary Unit, Kazan Federal University.
420012, Russia, Kazan, Butlerova str. 49. Tel.: +79047640987. E-mail: akridared@yahoo.com
Ustinova Elena Mikhailovna, doctor – specialist in ultrasound diagnostics of female consultation, Medical Sanitary Unit, Kazan Federal University.
420012, Russia, Kazan, Dostoevskogo str. 44/6. Tel.: +78432362171. E-mail: Elenadoc64@gmail.com
For citations: Klyucharov I.V., Morozov V.V., Gaineeva Z.A., Klivlend G.O.,
Ustinova E.M. The safety and tolerability of Bettocchi operative hysteroscopy in a women’s
health clinic. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (7): 114-9. (in Russian)
http://dx.doi.org/10.18565/aig.2017.7.114-9
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