1. OUR EXPERIENCE IN OUTPATIENT OPERATIVE HYSTEROSCOPY Corina Vasile, Giuseppe Sacco Dept. Gynaecology Obstetrics Mirano (Venice) Hospital- ITALY

2. OUT PATIENT OPERATIVE HYSTEROSCOPY Nowadays the development of new small caliber instruments and techniques determined an increased patients compliance during outpatient hysteroscopic procedures

3. Bettocchi S Operative Office hysteroscopy without anaesthesia: analysis of 4863 cases performed with mechanical instruments J Am Assoc Gynecol Laparosc, 2004 Marsh F A randomised controlled trial comparing outpatient versus daycase endometrial polypectomy, BJOG, 2006 Litta P Outpatient operative polypectomy using a 5 mm hysteroscope without anesthesia and/or analgesia: advantages and limits Eur J Obstet Gynecol&Reprod Biol, 2008 Di Spiezio Sardo A, Taylor A et al Hysteroscopy: a technique for all?Analysis of 5000 outpatient hysteroscopies Fertil Steril 2008

4. OFFICE OPERATIVE HYSTEROSCOPY NO TOUCH TECHNIQUE Operative double flow Minihysteroscopes Bipolar minielectrods Mechanical mininstruments

5. OUR EXPERIENCE - MATERIALS Between September 2009 and September 2011 142 patients underwent operative outpatient hysteroscopic procedures median age 46 yrs (23-74) Without anaesthesiologic support in an outpatient setting Pain level was determined using an analogic score from 0 to 10

6. OUR EXPERIENCE - METHODS Instruments ● 30 grade Hopkins II rod lens 2.9 mm telescope ● 5 mm continuous flow office Hysteroscope (Bettocchi Office Hysteroscope size 5; Karl Storz GmbH & Co., Tuttlingen, Germany). ● 5 Fr. working channel ● 1.6 mm diameter mechanical forceps and grasper ● Bipolar non disposable electrodes coaxial and curved ( Karl Storz GmbH & Co. Tuttlingen, Germany) ● Saline distension medium ● Endomat pump – medium pressure 60 mm Hg ● Vaginoscopic no touch technique ● Essure inserts by Conceptus Inc/ Cremascoli Iris ● Image data archive Cremascoli Iris srl Milano patients were monitored for 1 hour after the procedure

7. OUR EXPERIENCE - RESULTS Polypectomy 80 cases Essure 30 cases Focal endometrial resection/ target biopsy 24 cases Adhesiolysis 8 cases

8. OUR EXPERIENCE - RESULTS ● Mean operative time – 14 min (range 5-19 min) ● Mean pain score – 3 (range 0-6) ● No complications occurred ● Out of 80 - 75 polypectomies were performed in outpatient setting feasibility 93% - mean diameter 1.5 cm (range 0.5 -3 cm) ● The duration of the procedure correlated with polyp size ● All 30 Essure sterilizations were successful – control after 3 months revealed normal positioned devices with complete tubal occlusion obtained

9. ● Pain is a determining factor for patients compliance in outpatient hysteroscopy ● The duration of the procedure must not exceed 15 minutes ● Polyps size correlates with duration of the procedure therefore with pain ● An attentive patients selection, the use of adequate miniinstruments and a good level of hysteroscopic “no touch” technique are mandatory in order to perform quick, painless and safe procedures ● Patients satisfaction with outpatient hysteroscopy is high ● Outpatient operative hysteroscopy is feasible and may substantially reduce the number of inpatient, operating room procedures reducing hospital costs CONCLUSIONS