%0 Journal Article
%T Feasibility of Office-Based Operative Hysteroscopy by a Tissue Removal System Without Anesthesia.
%A Mor M
%A Kochav MG
%A Ezratty J
%A Dovev MN
%A Eisenberg N
%A Smorgick N
%J J Minim Invasive Gynecol
%V 31
%N 8
%D 2024 Aug 11
%M 38740128
%F 4.314
%R 10.1016/j.jmig.2024.05.005
%X <B>OBJECTIVE: </B>To investigate the feasibility of operative hysteroscopy by a hysteroscopic tissue removal system (HTRS) without anesthesia in women with endometrial polyps (EP) or retained products of conception (RPOC).<BR><B>METHODS: </B>Prospective observational cohort study.<BR><B>METHODS: </B>University-affiliated Department of Obstetrics and Gynecology.<BR><B>METHODS: </B>Consenting women aged >18 years diagnosed with EP or RPOC from 9/2022 to 8/2023 confirmed by a prior office hysteroscopy.<BR><B>METHODS: </B>Office-based vaginoscopic operative hysteroscopy without anesthesia using the Mini-Elite Truclear HTRS. Oral misoprostol was prescribed for cervical ripening. The patients rated intraoperative and 5-minute postoperative pain levels on a visual analog scale, with mild pain defined as a score of 0 to 4, moderate as 5 to 7, and severe as 8 to 10. A successful procedure was defined as complete removal of the pathology.<BR><B>RESULTS: </B>Fifty patients were included in this pilot study, and 47 (94.0%) procedures were completed successfully, including 21/24 (87.5%) cases of EP and all cases of RPOC (26/26, p = .06). No intra- or postoperative complications occurred. The intraoperative pain levels were rated as mild, moderate, and severe by 26 (52.0%), 16 (32.0%) and 8 (16.0%) patients, respectively. Severe intraoperative pain was more common in nulliparous women and those >10 years from their last vaginal delivery and was not associated with patient age, menopausal status, presence of abnormal uterine bleeding, or pathology size. Severe postoperative pain, reported by 5 (10.0%) patients, was significantly associated with removal of EP compared with RPOC, longer operative time, and nulliparity or >10 years from the last vaginal delivery. The procedure was considered acceptable by 46 (92.0%) patients, and 45 (90.0%) would recommend it to a friend/relative.<BR><B>CONCLUSIONS: </B>Office-based operative hysteroscopy by the HTRS is successful and well tolerated by most women, especially for RPOC removal.