Three Thousand Cases of Office Hysteroscopy: See and Treat an Indian Experience
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ORIGINAL ARTICLE
Three Thousand Cases of Office Hysteroscopy: See and Treat an Indian Experience Milind Telang1 · Theertha S. Shetty1 · Seema S. Puntambekar1 · Pravada M. Telang1 · Shakti Panchal1 · Yogita Alnure1 Received: 6 August 2019 / Accepted: 10 June 2020 © Federation of Obstetric & Gynecological Societies of India 2020
Abstract Study Objective Assessment of feasibility of office hysteroscopy in Indian setting. Design Retrospective study design. Setting Tertiary care centre: Galaxy care Hospital, Pune, India. Patients Three thousand consecutive women undergoing office hysteroscopy between 2012 and May 2018. Interventions Office hysteroscopy 2200 cases (2012–2017) with Bettocchi 2.9 scope and Hamou endomat. Eight hundred cases (2017–2018) with Bettocchi 1.9 scope and EASI. Normal saline was used as distension medium. With Hamou endomat, settings have drip rate of 200 ml/min with irrigation pressure of 75 mmHg and suction bar 0.15. With EASI, settings were for Bettocchi 4 (1.9 mm) and Bettocchi 5 (2.9 mm) scope with 45 mmHg. Hysteroscopies were carried out by an experienced operator trained in office hysteroscopy. All hysteroscopies were done in early proliferative phase (4th–11th day). Main Outcome Measures Success, failure and complication rates. Results Hysteroscopies were successfully performed in nearly 98.66% of cases with 4 patients requiring a two-step procedure due to > 3 cm pathology. One thousand eight hundred eight (62.2%) were diagnostic hysteroscopies, while operative hysteroscopies were performed in one thousand one hundred twenty (37.8%). One patient (1/3000) had a vasovagal attack. Conclusions In outpatient setting, counselling the patient for office hysteroscopy played an important role to overcome pain and anxiety, in addition to low pressure, continuous flow irrigation and vaginoscopic approach. Traditional resectoscopic surgeries should be reserved for challenging cases (i.e. endometrial ablation) or for certain pathologies (myomas > 2.0 cm, broad-base, large-size polyps). Recent advances in technique and instrumentation facilitate this approach and might encourage Dr. Milind Telang is a Chief Gynecologist, Department of Obstetrics and Gynecology, Galaxy Care Hospital, 25-A, Ayurveda Rasashala Premises, Karve Road, Pune, Maharashtra, India. Dr. Theertha Shetty is a Gynecology Fellow, Department of Obstetrics and Gynecology, Galaxy Care Hospital, 25-A, Ayurveda Rasashala Premises, Karve Road, Pune, Maharashtra, India. Dr. Seema Puntambekar is an Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Galaxy Care Hospital, 25-A, Ayurveda Rasashala Premises, Karve Road, Pune, Maharashtra, India. Dr. Pravada M. Telang is a Consultant, Department of Obstetrics and Gynecology, Galaxy Care Hospital, 25-A, Ayurveda Rasashala Premises, Karve Road, Pune, Maharashtra, India. Dr. Shakti Panchal is a Gynecology Fellow, Department of Obstetrics and Gynecology, Galaxy Care Hospital, 25-A, Ayurveda Rasashala Premises, Karve Road, Pune, Maharashtra, India. Dr. Yogita Alnure is a G
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