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Vitagliano A, Dellino M, Favilli A, D' Amato A, Nicolì P, Laganà AS, Noventa M, Bochicchio MA, Cicinelli E, Damiani GR. Patients' Use of Virtual Reality Technology for Pain Reduction during Outpatient Hysteroscopy: A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2023; 30:866-876. [PMID: 37648150 DOI: 10.1016/j.jmig.2023.08.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To summarize evidence from randomized controlled trials (RCTs) on the effectiveness of virtual reality technology (VRT), as used by patients, for reducing pain during outpatient hysteroscopy. DATA SOURCES Electronic databases and clinical registers were searched until June 21, 2023. The review protocol was registered in PROSPERO before the data extraction (CRD42023434340). METHODS OF STUDY SELECTION We included RCTs of patients receiving VRT compared with controls receiving routine care during outpatient hysteroscopy. TABULATION, INTEGRATION, AND RESULTS The primary outcome was average pain during hysteroscopy. Pooled results were expressed as mean differences (MDs) with 95% confidence interval (CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. Five RCTs were included (435 participants). The comparison between the intervention and control groups showed a borderline difference in perceived pain during hysteroscopy (MD -0.88, 95% CI -1.77 to 0.01). Subgroup analysis based on the type of VRT (active or passive) indicated that active VRT potentially reduced the perception of pain (MD -1.42, 95% CI -2.21 to -0.62), whereas passive VRT had no effect (MD -0.06, 95% CI -1.15 to 1.03). CONCLUSION Patients' use of active VRT may be associated with a reduction in pain during outpatient hysteroscopy (evidence Grading of Recommendations Assessment, Development, and Evaluation 2/4). Future research should focus on conducting methodologically robust studies with larger sample sizes and more homogeneous populations.
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Affiliation(s)
- Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy.
| | - Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery (Drs. Favilli), University of Perugia, Perugia, Italy
| | - Antonio D' Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Pierpaolo Nicolì
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) (Dr. Laganà), University of Palermo, Palermo, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health (Dr. Noventa), University of Padua, Padua, Italy
| | | | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
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Malu A, Patvekar M, Kolate D, Laxmi KD. Ambulatory Hysteroscopy: Evaluating Pain and Determining Factors. J Obstet Gynaecol India 2023; 73:434-439. [PMID: 37916053 PMCID: PMC10616044 DOI: 10.1007/s13224-023-01811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/07/2023] [Indexed: 11/03/2023] Open
Abstract
Study objective To measure pain using a visual analogue scale (VAS) and analyse its relationships with variables such as menopausal status, parity, uterine and cervical pathology, procedure length, and anxiety in patients undergoing ambulatory hysteroscopy (AH). Design Prospective observational study. Setting Dr DY Patil Medical Hospital and Research Centre, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune. Patients Seventy-five women. Intervention Ambulatory hysteroscopy(AH). Methodology AH was performed in seventy-five patients using vaginoscopic approach. At the end of the procedure, the intensity of pain was assessed using the visual analogue scale (VAS), from the score of 0 (no pain) to 10 (intolerable pain). The factors determining pain were assessed. Results Patients who underwent AH reported mild pain in 66% of cases, moderate pain in 22%, and severe pain in 12% of cases. The most frequent reason for referral was abnormal uterine bleeding (AUB).In the moderate pain group, the bivariate analysis was statistically significant for menopausal status (P values < 0.001), cervical pathology (< 0.001), and duration of procedure (0.001) and in multivariate analysis nulliparity (0.001) and menopausal status (0.001) were the significant determining factors.In severe pain group, the bivariate analysis was statistically significant for cervical pathology (P value = 0.001) and in multivariate analysis cervical pathology (0.003) and uterine pathology (0.002) were the significant determining factors. Conclusion Hysteroscopy is a safe, painless and a gold standard procedure. Pain experienced during AH was significantly influenced by cervical pathology. Gynaecologists in practise should receive training and start using AH to assess the endometrial cavity.
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Affiliation(s)
- Avisha Malu
- Department of Obstetrics and Gynaecology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra 411018 India
| | - Meenal Patvekar
- Department of Obstetrics and Gynaecology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra 411018 India
| | - Dipak Kolate
- Department of Obstetrics and Gynaecology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra 411018 India
| | - Kale Dhana Laxmi
- Department of Obstetrics and Gynaecology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra 411018 India
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Mazzon I, Etrusco A, Laganà AS, Chiantera V, Di Angelo Antonio S, Tosto V, Gerli S, Favilli A. Training in Diagnostic Hysteroscopy: The "Arbor Vitae" Method. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1019. [PMID: 37374222 PMCID: PMC10302144 DOI: 10.3390/medicina59061019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Diagnostic hysteroscopy is the gold standard in the diagnosis of intrauterine pathology and is becoming an essential tool in the daily practice of gynecology. Training programs for physicians are necessary to ensure adequate preparation and learning curve before approaching patients. The aim of this study was to describe the "Arbor Vitae" method for training in diagnostic hysteroscopy and to test its impact on the knowledge and skills of trainees using a customized questionnaire. Materials and Methods: A three-day hysteroscopy workshop combining theory and practical "hands on "sessions with dry and wet labs has been described. The aim of the course is to teach indications, instruments, the basic principles of the technique by which the procedure should be performed, and how to recognize and manage the pathologies that can be identified by diagnostic hysteroscopy. To test this training method and its impact on the knowledge and skills of the trainees, a customized 10-question questionnaire was administered before and after the course. Results: The questionnaire was administered to 34 participants. All trainees completed the questionnaire, and no missing responses were recorded. Regarding the characteristics of the participants, 76.5% had less than 1 year of experience in performing diagnostic hysteroscopy and 55.9% reported performing fewer than 15 procedures in their career. For 9 of the 10 questions embedded in the questionnaire, there was a significant improvement in the scores between pre- and post-course, demonstrating a perceived significant improvement in theoretical/practical skills by the trainees. Conclusions: The Arbor Vitae training model is a realistic and effective way to improve the theoretical and practical skills required to perform correct diagnostic hysteroscopy. This training model has great potential for novice practitioners to achieve an adequate level of proficiency before performing diagnostic hysteroscopy on live patients.
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Affiliation(s)
- Ivan Mazzon
- Arbor Vitae Endoscopic Centre, 00191 Rome, Italy; (I.M.); (S.D.A.A.)
| | - Andrea Etrusco
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | | | - Valentina Tosto
- Centre for Research in Perinatal and Reproductive Medicine, University of Perugia, 06123 Perugia, Italy;
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, 06123 Perugia, Italy;
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, 06123 Perugia, Italy;
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Guraslan H, Senturk MB, Dogan K, Yuksel B, Kaya C, Karacan T, Karabay Akgul O, Ceylan Y. Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope? J Obstet Gynaecol Res 2022; 48:1418-1425. [PMID: 35274418 DOI: 10.1111/jog.15219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/16/2021] [Accepted: 02/28/2022] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. METHODS A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. RESULTS Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. CONCLUSION In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.
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Affiliation(s)
- Hakan Guraslan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet B Senturk
- Department of Obstetrics and Gynecology, Tekirdag Namik Kemal University, Tekirdag /, Turkey
| | - Keziban Dogan
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Berkay Yuksel
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Tolga Karacan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Karabay Akgul
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasin Ceylan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Jansa V, Laganà AS, Ferrari F, Ghezzi F, Burnik Papler T, Vrtacnik Bokal E, Ban Frangež H. Uterine rupture in pregnancy after hysteroscopic septum resection: a 20-year retrospective analysis. MINIM INVASIV THER 2020; 31:448-455. [PMID: 33331203 DOI: 10.1080/13645706.2020.1837884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In this study, we reviewed the cases of uterine rupture in our setting, identified which of them had previously undergone hysteroscopic septum resection (HSR), and evaluated the main clinical characteristics for each case. MATERIAL AND METHODS We retrospectively analyzed (ClinicalTrial ID: NCT04449640) the delivery outcomes from the National Perinatal Information System of the National Institute of Public Health of the Republic of Slovenia of the last 20 years (1 January 1999 - 31 December 2019) and cross-linked the patients with surgical data from our electronic database. We collected baseline characteristics, surgical details and obstetrical outcomes. We excluded women who had undergone previous myomectomy or cesarean section (CS) and described the clinical course of each case since no statistical analysis was performed. RESULTS We found four patients who had uterine rupture in pregnancy after HSR. Median time to pregnancy was 17 months (range 1-60), all the women underwent CS and fetal-maternal outcomes were acceptable in half of the cases. Symptoms were nonspecific and included pain, fetal distress and vaginal bleeding. CONCLUSION Uterine rupture in pregnancy after a previous HSR is a very rare, but life-threatening event. Prompt diagnosis can ensure successful management and avoid adverse maternal-fetal outcomes.
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Affiliation(s)
- Vid Jansa
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Tanja Burnik Papler
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtacnik Bokal
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Ferrari F, Forte S, Arrigoni G, Ardighieri L, Coppola MC, Salinaro F, Barra F, Sartori E, Odicino F. Impact of endometrial sampling technique and biopsy volume on the diagnostic accuracy of endometrial cancer. Transl Cancer Res 2020; 9:7697-7705. [PMID: 35117372 PMCID: PMC8799147 DOI: 10.21037/tcr-20-2074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Histotype and tumor grading of endometrial cancer are the most important factors that have to be assessed by preoperative endometrial sampling, and their concordance with the final surgical and definitive histological findings is of paramount importance. We aim to compare histotype and tumor grading concordance of various endometrial sampling techniques (ESTs) and to investigate the role of endometrial volume biopsy. METHODS We performed a retrospective analysis of patients with apparent early stage endometrial cancer collecting demographic, clinical data, type of EST, pathological characteristics of endometrial biopsies and final specimens. We classified ESTs as dilation and curettage (D&C), diagnostic hysteroscopy with D&C, outpatient hysteroscopy and operative hysteroscopy with or without D&C. Diagnostic and operative hysteroscopy were performed with Bettocchi's 5 mm hysteroscope. We evaluated concordance for histotype, and tumor grading, and we performed subgroup analysis based on the technique and final tumor grading. Concordance was classified from good, moderate, sufficient, fair, poor and none using Cohen k-statistic. Finally, we investigated the existence of independent risk factors for discordant tumor grading using multivariate binary logistic regression. RESULTS We collected 148 patients and of these 131 (88.5%) were diagnosed with endometrioid histotype and 65 (44%), 46 (31%) and 37 (25%) respectively with well, moderate and poor differentiated tumors. Atypical hyperplasia (AH) was detected preoperatively in 28 patients (19%). Histotype concordance was fair (k=0.35) and tumor grading concordance was moderate (k=0.45); particularly, concordance was fair in well-differentiated cases (k=0.38); concordance was moderate in moderate- and poor-differentiated cases (k=0.52) and good (k=0.71). Operative hysteroscopy showed moderate concordance for histotype (k=0.41), while grading concordance was fair for G1 (k=0.41), moderate for G2 (k=0.58) and good for G3 (k=0.72), regardless the use of D&C. Preoperative volume biopsy did not impact the concordance of tumor grading, while the adoption of operative hysteroscopy (with or without D&C) decreased the risk of grading discordance in G3 tumors (HR 0.17; 95% CI: 0.03-0.94; P=0.04). Conversely, time elapsed from diagnosis to treatment in well-differentiated tumors increased the risk of discordant results (HR 1.06; 95% CI: 1.02-1.52; P=0.04). CONCLUSIONS Operative hysteroscopy demonstrated the best tumor grading concordance, especially in poor-differentiated tumors. The volume of biopsy did not affect the tumor grading concordance.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Sara Forte
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Giulia Arrigoni
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, Spedali Civili of Brescia, Brescia, Italy
| | | | - Federica Salinaro
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Enrico Sartori
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
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Török P, Molnár S, Herman T, Jashanjeet S, Lampé R, Riemma G, Vitale SG. Fallopian tubal obstruction is associated with increased pain experienced during office hysteroscopy: a retrospective study. Updates Surg 2020; 72:213-218. [PMID: 31993995 DOI: 10.1007/s13304-020-00712-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
This study aimed at evaluating the pain experienced during office hysteroscopy, with selective tubal cannulation and chromopertubation, by women with and without tubal obstruction in order to determine if such condition would be associated with increased pain during the examination. Women with a history of infertility underwent in-office hysteroscopy with selective chromopertubation using a continuous flow office hysteroscope with a 5 Fr operating channel fitted with a 4 Fr catheter for the injection of methylene blue dye. Experienced pain was recorded on a Visual Analog Scale (VAS) during diagnostic hysteroscopy after access to the uterine cavity. Of 90 women, 58 (66.4%) were found with at least one patent fallopian tube and inserted in the group "any", meanwhile 32 (33.6%) were categorized into group "none" as both tubes were judged obstructed. There was no significant difference between groups in BMI and primary infertility rate, but the difference was significant concerning mean age (32.6 vs. 35.8; p < 0.001). The mean VAS score was 3.34 (± 1.07) in the group "any" and 4.25 (± 1.11) in "none". Comparing the VAS score of the two groups, the difference was significant (p < 0.001). Tubal occlusion may have a potential role in the pain experienced by women undergoing in-office hysteroscopy. Women with bilateral tubal occlusion experienced a higher level of pain compared with patients with at least one patent fallopian tube. Operators may use milder intrauterine pressure of fluid distension medium when these patients are undergoing in-office hysteroscopy to reduce discomfort.
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Affiliation(s)
- Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Singh Jashanjeet
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
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Török P, Herman T, Lőrincz J, Molnár S, Lampé R, Póka R. Suprapubic pressure facilitates the procedure of office hysteroscopy: A randomized controlled trial. J Obstet Gynaecol Res 2018; 45:640-644. [PMID: 30362211 DOI: 10.1111/jog.13848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Abstract
AIM To minimize the experienced pain during office hysteroscopy, a number of technical approaches and maneuvers are used. The aim of the study was to assess the effect of suprapubic pressure (SuPuP) applied during hysteroscopy. The impact of this maneuver on experienced pain (assessed by visual analog scale [VAS]) and duration of passage through the cervical canal was measured and compared to a reference group with no SuPuP. METHODS Hysteroscopy was performed in study subjects as part of their infertility work-up. Patients were randomized into two groups as part of a controlled trial. In group 1, SuPuP was applied while inserting the scope; in group 2, SuPuP was not applied. Pain experienced during the procedure was measured on a 0-10 VAS. Duration of passage through the cervical canal was measured by analyzing the video of the procedure. The effect of SuPuP was estimated by testing for between-groups differences in these outcomes. RESULTS The number of patients included the study was 60. Mean (SD) VAS score was 3.40 (1.276) in group 1 compared to 3.33 (0.802) in group 2 (P = 0.809). Mean (SD) time of passage through the cervical canal in group 1 was 30.5 (18.37) seconds compared to 43.0 (24.51) seconds in group 2 (P = 0.029). CONCLUSION Applying suprapubic pressure could facilitate the procedure by significantly shortening the duration of the passage through the cervical canal, but significantly not reduces the pain experienced during hysteroscopy. Further studies are to be undertaken to investigate the advantages of suprapubic pressure during office hysteroscopy.
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Affiliation(s)
- Péter Török
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Judit Lőrincz
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Róbert Póka
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
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Karaman E, Kolusarı A, Çetin O, Çim N, Alkış İ, Karaman Y, Güler S. What should the optimal intrauterine pressure be during outpatient diagnostic hysteroscopy? A randomized comparative study. J Obstet Gynaecol Res 2017; 43:902-908. [PMID: 28429539 DOI: 10.1111/jog.13293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/10/2016] [Accepted: 12/24/2016] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate and compare lower and higher uterine filling pressures during outpatient diagnostic hysteroscopy. METHODS One hundred and seventy-five women eligible for outpatient diagnostic hysteroscopy were included in this randomized double blind comparative study. The subjects were randomized into two groups. Group 1 (n = 80) underwent surgery with lower intrauterine filling pressures (30, 40, and 50 mmHg) and group 2 (n = 81) underwent surgery with higher filling pressures (70, 80, and 100 mmHg). The primary outcome measure was adequate visibility during the procedure. The secondary outcome measure was pain perceived by the patient during and 30 min after the procedure. RESULTS In total, 161 patients completed the trial. Group 2 had significantly higher adequate visibility than group 1 (71/80, 88.75% in group 1 and 79/81, 97.5% in group 2, P = 0.008). There was a trend toward increase in pain scores with higher pressures during the procedure. However, there were no significant differences between the two groups in terms of visual analog scale pain scores measured 30 min after the procedure. CONCLUSION Lower uterine filling pressure was associated with lower pain scores with a higher trend towards inadequate visibility. It appears that higher filling pressure can be used for performing office hysteroscopy, but it is associated with higher pain scores.
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Affiliation(s)
- Erbil Karaman
- Medical Faculty, Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey
| | - Ali Kolusarı
- Medical Faculty, Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey
| | - Orkun Çetin
- Medical Faculty, Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey
| | - Numan Çim
- Medical Faculty, Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey
| | - İsmet Alkış
- Medical Faculty, Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey
| | - Yasemin Karaman
- Department of Obstetrics and Gynecology, Van Private Lokman Hekim Hayat Hospital, Van, Turkey
| | - Seyithan Güler
- Medical Faculty, Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey
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Wahba AH, Hassan AM, Kotb M, ElShenoufy H, Haggag HM. Impact of Uterine Scar on Pain Experienced During Outpatient Hysteroscopy: A Prospective Blinded Comparative Study. J Minim Invasive Gynecol 2017; 24:626-631. [PMID: 28161494 DOI: 10.1016/j.jmig.2017.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/19/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To study the impact of uterine scar on pain experienced during outpatient hysteroscopy. DESIGN A prospective blinded comparative study (Canadian Task Force classification II-1). SETTING Outpatient hysteroscopy clinic at a university hospital. PATIENTS We included 140 women in the childbearing period attending an outpatient hysteroscopy clinic. Patients were divided into 2 groups. Group A included patients with previous uterine scar (n = 70) and Group B included those with unscarred uterus (n = 70). None of the patients had a previous attempt of a vaginal delivery. INTERVENTION Diagnostic outpatient hysteroscopy without the use of anesthesia or analgesia. MEASUREMENTS We assessed pain experienced during and immediately after the procedure using a 100-mm visual analog scale. We also evaluated the successful completion of the procedure. RESULTS There were no statistically significant differences in the pain scores between patients with scarred uterus and those with unscarred uterus during or immediately after the procedure. The procedure was aborted in only 1 case in the scarred uterus group. This patient had a history of surgical site infection, which may denote a weak scar. There were no statistically significant differences in pain scores between patients with cesarean scar and those with myomectomy scar. No statistically significant differences in pain scores were found between patients with 1, 2, 3, or 4 cesarean deliveries. CONCLUSION Uncomplicated uterine scars do not have an impact on pain experienced during or immediately after diagnostic outpatient hysteroscopy using a 3.8-mm hysteroscope.
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Affiliation(s)
- Amr H Wahba
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.
| | | | - Mohamed Kotb
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hossam ElShenoufy
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hisham M Haggag
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt; Department of Obstetrics and Gynecology, University of Wuerzburg, Wuerzburg, Germany
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Hysteroscopic metroplasty for the septate uterus with diode laser: a pilot study. Eur J Obstet Gynecol Reprod Biol 2016; 206:32-35. [DOI: 10.1016/j.ejogrb.2016.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/05/2016] [Accepted: 08/13/2016] [Indexed: 11/19/2022]
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Pain in office hysteroscopy: it is not just a matter of size. Comment on: "Paulo AA, Solheiro MH, Paulo CO. Is pain better tolerated with mini-hysteroscopy than with conventional device? A systematic review and meta-analysis: hysteroscopy scope size and pain. Arch Gynecol Obstet. 2015 May 7". Arch Gynecol Obstet 2016; 293:687-8. [PMID: 26721830 DOI: 10.1007/s00404-015-3997-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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Senturk MB, Guraslan H, Babaoğlu B, Yaşar L, Polat M. The Effect of Intrauterine Lidocaine and Rectal Indomethacin on Pain during Office Vaginoscopic Hysteroscopy: Randomized Double-Blind Controlled Study. Gynecol Obstet Invest 2015; 81:280-4. [DOI: 10.1159/000441787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
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