Review ArticleHysteroscopy without Anesthesia: Review of Recent Literature
Section snippets
Materials and Methods
A search of the PubMed database from 199 to the present was performed using the keywords “Anesthesia, “Hysteroscopy”, and “Pain.” Seventy-nine articles about both diagnostic and operative hysteroscopy were retrieved.
First, the causes of pain in simple exploration (diagnostic hysteroscopy) were examined; however, it must be remembered that the same factors influence pain perception and need for anesthesia in operative procedures.
Operative Hysteroscopy
Operative hysteroscopes sized 5 mm or smaller equipped with a 5F operative canal have enabled many surgical procedures to be performed in an office setting, with local or no anesthesia 32, 33, 34. The realization of 5F forceps, and especially of a bipolar coaxial electrode (Gynecare VersaPoint; Ethicon Inc., Somerville, NJ), has enabled the therapeutic possibility of office hysteroscopy, and currently many intrauterine diseases may be treated immediately after diagnosis, that is, using the
Conclusions
In a growing number of women, hysteroscopic procedures can be successfully performed in an office setting without any anesthesia. Diagnostic minihysteroscopy using 3.5-mm instruments is less painful and easier to perform than hysteroscopy performed using 5-cm instruments. However, severe pain and adverse effects may occur rarely even with mini-instruments. Women with a history of cesarean section, chronic pelvic pain, or anxiety, or are menopausal should be considered at risk of pain
References (44)
- et al.
Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women
J Am Assoc Gynecol Laparosc
(2001) - et al.
Office hysteroscopy
Obstet Gynecol Clin North Am
(2004) - et al.
Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases
Fertil Steril
(2003) Diagnostic minihysteroscopy with vaginoscopic approach: rationale and advantages
J Minim Invasive Gynecol
(2005)- et al.
Hysteroscopy: a technique for all? Analysis of 5,000 outpatient hysteroscopies
Fertil Steril
(2008) - et al.
Carbon dioxide versus normal saline as a uterine distension medium for diagnostic vaginoscopic hysteroscopy in infertile patients: a prospective, randomized, multicenter study
Fertil Steril
(2003) - et al.
Use of carbon dioxide versus normal saline for diagnostic hysteroscopy
Fertil Steril
(2003) - et al.
Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study
J Minim Invasive Gynecol
(2007) - et al.
Compliance and diagnostic efficacy of mini-hysteroscopy versus traditional hysteroscopy in infertility investigation
Eur J Obstet Gynecol Reprod Biol
(2007) - et al.
Tolerability and cardiovascular complications of outpatient diagnostic minihysteroscopy compared with conventional hysteroscopy
J Am Assoc Gynecol Laparosc
(2003)
Numerous indications for office flexible minihysteroscopy
J Am Assoc Gynecol Laparosc
Use of sublingual buprenorphine for pain relief in office hysteroscopy
J Minim Invasive Gynecol
The technique and overview of flexible hysteroscopy
Obstet Gynecol Clin North Am
Efficacy of office diagnostic hysterofibroscopy
J Minim Invasive Gynecol
2500 Outpatient diagnostic hysteroscopies
Obstet Gynecol
Predictive factors for pain experienced at office fluid minihysteroscopy
J Minin Invasive Gynecol
Good practice and accuracy of office hysteroscopy and endometrial biopsy
J Gynecol Obstet Biol Reprod (Paris)
Outpatient hysteroscopic polypectomy in 237 patients: feasibility of a one-stop “see-and-treat” procedure
J Am Assoc Gynecol Laparosc
Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments
J Am Assoc Gynecol Laparosc
Hysteroscopic polypectomy in the office without anesthesia
J Am Assoc Gynecol Laparosc
Outpatient hysteroscopic polypectomy in postmenopausal women: a comparison between mechanical and electrosurgical resection
J Minim Invasive Gynecol
Outpatient operative polypectomy using a 5 mm-hysteroscope without anaesthesia and/or analgesia: advantages and limits
Eur J Obstet Gynecol Reprod Biol
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