Operative Hysteroscopy in an Office-Based Surgical Setting: Review of Patient Safety and Satisfaction in 414 Cases

Study Objective: To determine the safety and satisfaction among patients undergoing operative hysteroscopy in an office-based setting. Design: Retrospective analysis (Canadian Task Force classification II-2). Setting: Physician's private office. Patients: Women undergoing operative hysteroscopy in an office setting. Interventions: Three hundred eighty-seven women underwent a total of 414 operative hysteroscopic procedures, with use of parenterally administered moderate sedation, a 9-mm operative resectoscope, and sonographic guidance. All patients were American Society of Anesthesiologists class I-III. Measurements and Main Results: A total of 305 primary operative hysteroscopic procedures were performed including endomyometrial resection, myomectomy, polypectomy, removal of a uterine septum, and adhesiolysis. One hundred nine (26.3%) repeat operative procedures were performed in women in whom previous endometrial ablation and resection had failed. The average procedure required a mean (SD) of 37.6 (13.5) minutes to complete, and produced 14.1 (10.2) g of tissue. Ninety-nine percent of all procedures were completed. Only 1 patient required a hospital transfer for evaluation of a uterine perforation necessitating diagnostic laparoscopy. There were 8 (1.9%) postoperative infections, and no complications attributable to use of conscious sedation. Two hundred fifty-five women (65.6%) responded to our telephone survey. Two hundred fifty-two (98.8%) respondents were either "very satisfied" or "satisfied." Two hundred forty-nine women (97.6%) preferred the office to a hospital setting, whereas 6 (2.4%) would have preferred a hospital setting. All but 5 respondents would recommend this procedure to a friend. Conclusion: Major operative hysteroscopic surgery can be performed in an office-based setting with a high degree of safety and patient satisfaction. Journal of Minimally Invasive Gynecology (2013) 20, 56-63 Published by Elsevier Inc. on behalf of AAGL.