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Abstract：
To identify technologies associated with the least operative pain in women undergoing operative office hysteroscopic procedures.
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched until January 2021 using a combination of keywords \"hysteroscop*,\" \"endometrial ablation,\" \"outpatient,\" \"ambulatory,\" \"office,\" and associated Medical Subject Headings.
Randomized controlled trials evaluating the effect of hysteroscopic devices on pain experienced by women undergoing operative office hysteroscopy were included. Data were also collected regarding efficacy, procedural time, adverse events, and patient/clinician acceptability and/or satisfaction.
The search returned 5347 records. Ten studies provided data for review. Two trials compared endometrial ablation using bipolar radiofrequency with thermal balloon energy, with no significant difference in pain observed (p <.05). Seven trials evaluated technologies for endometrial polypectomy, of which, 4 compared energy modalities: miniature bipolar electrode resection against resectoscopy (N = 1), morcellation (N = 2), and diode laser resection (N = 1). Two studies compared hysteroscope diameter, and one study compared methods of polyp retrieval. A significant reduction in pain was found using morcellators rather than miniature bipolar electrosurgical devices (p <.001), 22Fr rather than 26Fr resectoscopes (p <.001), and 3.5-mm fiber-optic hysteroscopes with 7Fr forceps rather than 5-mm lens-based hysteroscopes with 5Fr forceps (p <.05). One study investigating septoplasty showed significant reduction in pain when cold mini-scissors, rather than a miniature bipolar electrode, were used (p = .013). Average procedural times ranged from 5 minutes 28 seconds to 22 minutes. The incidence of adverse events was low, and data regarding efficacy and acceptability/satisfaction were limited.
Pain is reduced when mechanical technologies such as morcellators and scissors are used compared with electrical devices for removing structural lesions in the office. For hysteroscopic and ablative procedures, smaller and quicker devices are less painful. Large-scale RCTs investigating patient pain and experience with modern operative devices in the office setting are urgently needed.
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched until January 2021 using a combination of keywords \"hysteroscop*,\" \"endometrial ablation,\" \"outpatient,\" \"ambulatory,\" \"office,\" and associated Medical Subject Headings.
Randomized controlled trials evaluating the effect of hysteroscopic devices on pain experienced by women undergoing operative office hysteroscopy were included. Data were also collected regarding efficacy, procedural time, adverse events, and patient/clinician acceptability and/or satisfaction.
The search returned 5347 records. Ten studies provided data for review. Two trials compared endometrial ablation using bipolar radiofrequency with thermal balloon energy, with no significant difference in pain observed (p <.05). Seven trials evaluated technologies for endometrial polypectomy, of which, 4 compared energy modalities: miniature bipolar electrode resection against resectoscopy (N = 1), morcellation (N = 2), and diode laser resection (N = 1). Two studies compared hysteroscope diameter, and one study compared methods of polyp retrieval. A significant reduction in pain was found using morcellators rather than miniature bipolar electrosurgical devices (p <.001), 22Fr rather than 26Fr resectoscopes (p <.001), and 3.5-mm fiber-optic hysteroscopes with 7Fr forceps rather than 5-mm lens-based hysteroscopes with 5Fr forceps (p <.05). One study investigating septoplasty showed significant reduction in pain when cold mini-scissors, rather than a miniature bipolar electrode, were used (p = .013). Average procedural times ranged from 5 minutes 28 seconds to 22 minutes. The incidence of adverse events was low, and data regarding efficacy and acceptability/satisfaction were limited.
Pain is reduced when mechanical technologies such as morcellators and scissors are used compared with electrical devices for removing structural lesions in the office. For hysteroscopic and ablative procedures, smaller and quicker devices are less painful. Large-scale RCTs investigating patient pain and experience with modern operative devices in the office setting are urgently needed.
摘要：
确定与接受手术办公室宫腔镜手术的女性手术疼痛最小相关的技术。
MEDLINE,Embase,护理和相关健康文献的累积指数，和Cochrane中央对照试验登记册使用关键字\“hysteroscop*”的组合进行搜索，直到2021年1月，\"\"子宫内膜消融术,\"\"门诊病人,\"\"走动，\"\"办公室,\“及相关医学主题词。
纳入随机对照试验，评估宫腔镜装置对接受手术办公室宫腔镜检查的女性疼痛的影响。还收集了有关疗效的数据，程序时间,不良事件,以及患者/临床医生的可接受性和/或满意度。
搜索返回了5347条记录。十项研究提供了数据供回顾。两项试验比较了使用双极射频和热气球能量的子宫内膜消融，观察到的疼痛没有显着差异（p<0.05）。七项试验评估了子宫内膜息肉切除术的技术，其中，4个比较的能量模式：微型双极电极切除与电切镜检查（N=1），分块(N=2)，和二极管激光切除(N=1)。两项研究比较了宫腔镜直径，一项研究比较了息肉的检索方法。使用粉碎器而不是微型双极电外科设备（p<.001），发现疼痛显着减少。22Fr而不是26Fr切除范围(p<.001)，和3.5毫米光纤宫腔镜与7Fr钳，而不是5毫米基于透镜的宫腔镜与5Fr钳（p<.05）。一项调查鼻中隔成形术的研究显示，当使用冷迷你剪刀时，疼痛显著减轻，而不是微型双极电极，使用（p=.013）。平均手术时间为5分钟28秒至22分钟。不良事件发生率低,有关疗效和可接受性/满意度的数据有限。
与用于去除办公室中的结构性病变的电气设备相比，使用机械技术（例如分割器和剪刀）可减少疼痛。对于宫腔镜和消融手术，更小、更快的设备不那么痛苦。迫切需要在办公室环境中调查患者疼痛和使用现代手术设备的经验的大规模RCT。
MEDLINE,Embase,护理和相关健康文献的累积指数，和Cochrane中央对照试验登记册使用关键字\“hysteroscop*”的组合进行搜索，直到2021年1月，\"\"子宫内膜消融术,\"\"门诊病人,\"\"走动，\"\"办公室,\“及相关医学主题词。
纳入随机对照试验，评估宫腔镜装置对接受手术办公室宫腔镜检查的女性疼痛的影响。还收集了有关疗效的数据，程序时间,不良事件,以及患者/临床医生的可接受性和/或满意度。
搜索返回了5347条记录。十项研究提供了数据供回顾。两项试验比较了使用双极射频和热气球能量的子宫内膜消融，观察到的疼痛没有显着差异（p<0.05）。七项试验评估了子宫内膜息肉切除术的技术，其中，4个比较的能量模式：微型双极电极切除与电切镜检查（N=1），分块(N=2)，和二极管激光切除(N=1)。两项研究比较了宫腔镜直径，一项研究比较了息肉的检索方法。使用粉碎器而不是微型双极电外科设备（p<.001），发现疼痛显着减少。22Fr而不是26Fr切除范围(p<.001)，和3.5毫米光纤宫腔镜与7Fr钳，而不是5毫米基于透镜的宫腔镜与5Fr钳（p<.05）。一项调查鼻中隔成形术的研究显示，当使用冷迷你剪刀时，疼痛显著减轻，而不是微型双极电极，使用（p=.013）。平均手术时间为5分钟28秒至22分钟。不良事件发生率低,有关疗效和可接受性/满意度的数据有限。
与用于去除办公室中的结构性病变的电气设备相比，使用机械技术（例如分割器和剪刀）可减少疼痛。对于宫腔镜和消融手术，更小、更快的设备不那么痛苦。迫切需要在办公室环境中调查患者疼痛和使用现代手术设备的经验的大规模RCT。
