Office hysteroscopy: a scientific overview

Introduction

Hysteroscopy (direct endoscopic visualization of the endometrial cavity) is considered the golden standard as a means to visualize the cervical canal and uterine cavity and to treat benign uterine pathology [1, 2]. It is relatively well established that hysteroscopy has equal or greater diagnostic accuracy than ultrasound, SIS (Saline Infusion Sonography) or blind endometrial biopsy techniques. It is also highly accurate in the identification and diagnosis of endometrial cancer, making it

a powerful diagnostic tool in the investigation of abnormal uterine bleeding, one of the most frequent reasons for which women seek gynaecological outpatient care. The past decade has seen rapid advances in this area with new instruments and modified techniques so that this procedure can now be performed in an outpatient setting, so called ambulatory or office-hysteroscopy. There is an emerging consensus among clinicians that this procedure is equally safe, has equal diagnostic potential and provides greater patient satisfaction than traditional hysteroscopy.

Despite the consensus among researchers and specialists in this field, discussion continues concerning the tolerability, feasibility and limitations of diagnostic and operative hysteroscopy in the ambulatory setting. Furthermore, despite its advantages, outpatient hysteroscopy is so far not widespread among outpatient clinics and has not gained general acceptance among clinicians [3]. This article aims to review hysteroscopy as a diagnostic and operational tool as well as to outline the major points in question concerning office hysteroscopy as compared to conventional hysteroscopy: its diagnostic and operational potential, and limitations.

The diagnostic and operational role of hysteroscopy

The challenge of outpatient gynaecological diagnostics is to clearly identify the relatively few patients in need of further inpatient investigation or surgery, from the majority with benign underlying pathology. Up to 25% of women at some point seek health care due to abnormal uterine bleeding [4] making this one of the most common, as well as physically and psychologically burdensome gynaecological conditions. Investigation of abnormal bleeding can be a lengthy process involving several patient visits and procedures, but using office hysteroscopy most conditions can be diagnosed and treated during one routine visit. This method...


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