ABSTRACT
Introduction Although operative hysteroscopy has progressively been accepted for the treatment of intrauterine pathologies, diagnostic hysteroscopy is still not widely and routinely used. Whereas almost all urologists utilize office cystoscopy to evaluate bladder pathology, it is estimated that less than 20% of gynecologists utilize office hysteroscopy to evaluate uterine pathology.1 Conventional hysteroscopy, defined as a procedure performed with an instrument of 5.0 mm total diameter and with CO2 as a distention medium and in which the insertion of the hysteroscope is facilitated by the use of a speculum and a tenaculum, has not been proven to be a technique accessible for all gynecologists and applicable in a routine set-up. Recently, well-conducted scientific studies have highlighted some important elements that can explain this underutilization of hysteroscopy as a first-line diagnostic procedure both in the office and in the conventional inpatient clinic. Nagele et al2 have proved that CO2 induces significantly more pain than a watery solution when used as distention medium.2 Furthermore, a watery distention medium has the advantage of cleaning the environment, leading to a better and easier visualization of the uterine cavity than with the conventional CO2. In a prospective randomized trial (PRT) we have recently proved the importance of the instrument diameter for both patient compliance and visualization quality.3 In the same study we also demonstrated that both the experience of the surgeon and the anatomical difficulties determined by patient’s parity play a key role when a conventional hysteroscope is used. With the use of a mini-hysteroscope, however, neither surgeon’s experience nor patient’s parity influence the results, offering a significant improvement for patient compliance and visualization quality. Office hysteroscopy is wrongly associated to a large extent with the disadvantages of conventional hysteroscopy and unfortunately many physicians, including gynecologists who do not witness the recent technical developments, believe that office hysteroscopy is similar to conventional hysteroscopy but performed in an office setting. In addition, the benefits of incorporating hysteroscopy as a first-line diagnostic tool
for the investigation of abnormal uterine bleeding (AUB)4,5
and infertility6-9 are still not completely assumed by the medical community, whereas the lack of expertise to perform the procedure is evident.
