Procedures

Question 1

What hysteroscope should be used in routine outpatient hysteroscopy?

Answer 1

miniature - 2.7mm with a 3-3.5mm sheath

Question 2

Comparison between CO2 and saline for distension in routine hysteroscopy

Answer 2

saline provides better view and quicker procedure than CO2 and is required as a conducting medium for bipolar electrosurgery, it is also associated with less vasovagal episodes
But neither are better at reducing pain

Question 3

What is the main use of routine hysteroscopy?

Answer 3

Assessment of abnormal uterine bleeding + assessment of infertility - can also be used for operative procedures including endometrial polypectomy/ablation/removal of subserosal fibroids and lost IUDs/cervical sterilisation

Question 4

What is the recovery of outpatient compared to day-case hysteroscopy?

Answer 4

mobilisation straight away vs 105 mins post op

recovery in 2 days vs 3 days post op

Question 5

What is the risk of uterine perforation during hysteroscopy?

Answer 5

up to 1.7%

Question 6

Analgesia pre hysteroscopy

Answer 6

avoid opiates, NSAIDs pre-op if suitable

Question 7

Risks of cervical dilatation

Answer 7

vasovagal episode, uterine trauma, pain - should not be performed routinely

Question 8

Benefit of local instillation of local anaesthesia to cervical canal in outpatient hysteroscopy (instillagel)

Answer 8

fewer vasovagal episodes but no pain reduction.

Question 9

What anaesthesia should be applied if a cervical tenaculum is used during outpatient hysteroscopy?

Answer 9

topical anaesthesia (instillagel) to the ectocervix

Question 10

When is intracervical or paracervical local anaesthesia advised in outpatient hysteoscopy

Answer 10

never routinely with minature hysteroscope

but if there is a requirement if hysteroscope is >5mm or there is cervical stenosis