Reliability, feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases

Objective: To assess the reliability, feasibility, and safety of lens-based minihysteroscopy. Design: Retrospective comparative study. Setting: Academic research environment. Patient(s): Women with different indications for hysteroscopy. Intervention (s): Six thousand seventeen outpatient diagnostic hysteroscopies with a minihysteroscope (2.7-mm outer diameter [OD] telescope with 3.5-mm OD single-flow diagnostic sheath) and 4,204 with traditional hysteroscope (4-mm OD telescope with 5-mm OD single-flow diagnostic sheath). All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus. Main Outcome Measure(s): Rate of successful introduction of the hysteroscope, rate of satisfactory examinations, pain intensity experienced using an arbitrary pain scale (0 = no pain; 1 = low pain; 2 moderate pain; 3 = severe pain), and number of side effects and complications. Result(s): In the minihysteroscopy, group rates of successful introduction and satisfactory examinations were significantly higher than in the traditional hysteroscope group (99.52% vs. 72.53% and 98.53% vs. 92.33%, respectively), while pain and vagal reactions were significantly lower (0.10 +/- 0.34 vs. 1.09 +/- 0.53 and 2.25% vs. 17.12%, respectively). Conclusion(s): Hysteroscopy with lens-based minihysteroscopes was easier, less painful, more reliable, and safer than with 5-mm hysteroscopes. Minihysteroscopy with a vaginoscopic approach is a very well tolerated, effective, and safe outpatient procedure. (C)2003 by American Society for Reproductive Medicine.