Best practice in outpatient hysteroscopy - GT59

Question 1

What analgesia can be used pre-operatively before an outpatient hysteroscopy?

Answer 1

Avoid opiates

Consider NSAIDs 1 hour before to reduce pain in post-op period (if no contraindications)

Question 2

What cervical preparation should be given prior to hysteroscopy as outpatient?

Answer 2

None

Question 3

Which type of hysteroscope should be used in the outpatient setting?

Answer 3

2.7mm with a 3-3.5mm sheath
Degree of scope up to operator preference
Rigid or flexible - up to operator

Question 4

What are the pros/cons of rigid hysteroscopes and flexible hysteroscopes?

Answer 4

Flexible - less pain

Rigid - Better pictures, less chance of failure, quicker procedure time, reduced costs

Question 5

Which distension medium should be used for outpatient hysteroscopy?

Answer 5

CO2 or saline - up to operator
Fewer vasovagals with saline and better images
Need saline if using bipolar electrosurgery

Question 6

What is the benefit of LA injection into the cervical canal / around the cervix during outpatient hysteroscopy?
When should it be used

Answer 6

Doesn’t reduce pain
May improve vasovagal reactions - not indicated for this

Around cervix - reduces pain but ?clinical significance
Consider in postmenopausal women
If scope is >5mm
If dilatation is expected e.g. stenosis

Question 7

When should vaginoscopy be used?

Answer 7

Standard technique

Especially if speculum insertion anticipated to be difficult and blind biopsy not required

Question 8

When should topical LA be used in OP hysteroscopy?

Answer 8

If tenaculum to be used

Question 9

What is the technique for paracervical block?

Answer 9

4 and 8 o’clock positions (can use 3 and 9)
Cervicovaginal junction vaginal mucosa 1-2 mls to blanche
Then advanced to 1-2.5 cm