Comparison of vaginoscopic hysteroscopy and traditional hysteroscopy: A systematic review and meta-analysis

BackgroundOutpatient hysteroscopy is a safe, feasible, and optimum procedure for the diagnosis and management of intrauterine pathologies. ObjectiveTo determine the best approach of outpatient hysteroscopy (vaginoscopic vs traditional) in terms of pain, duration of procedure, feasibility, safety, and acceptability. Search StrategyPubMed, Embase, Google Scholar, and Scopus were searched from January 2000 to October 2021. No filters or restrictions were applied. Selection CriteriaRandomized controlled trials comparing vaginoscopic hysteroscopy with traditional hysteroscopy in an outpatient setting. Data Collection and AnalysisTwo authors independently performed a comprehensive literature search and collected and extracted data. The summary effect estimate was determined using both fixed effects and random-effects models. ResultsSeven studies with 2723 patients (vaginoscopic [n = 1378] and traditional hysteroscopy [n = 1345]) were included. Vaginoscopic hysteroscopy was associated with a significant reduction in intraprocedural pain (standardized mean difference, -0.05 [95% confidence interval (CI), -0.33 to -0.23], I-2 = 0%), procedural time (standardized mean difference, -0.45 [95% CI, -0.76 to -0.14], I-2 = 82%), and fewer side effects (relative risk, 0.37 [95% CI, 0.15-0.91], I-2 = 0%). The procedure failure rate was similar in both approaches (relative risk, 0.97 [95% CI, 0.71-1.32], I-2 = 43%). Complications were mostly documented with traditional hysteroscopy. ConclusionVaginoscopic hysteroscopy reduces the pain and duration compared with traditional hysteroscopy.