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Obstetrics & Gynecology 2006;108:387-392
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

A New Approach to Office Hysteroscopy Compared With Traditional Hysteroscopy

A Randomized Controlled Trial

Ron Sagiv, MD1, Oscar Sadan, MD1, Mona Boaz, PhD3, Michal Dishi, MD1, Edwardo Schechter, MD2 and Abraham Golan, MD, FRCOG1

From the 1 Department of Obstetrics and Gynecology, 3 Epidemiology and Research Unit, Edith Wolfson Medical Center, 2 Maccabi Women Health Care, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

OBJECTIVE: To compare a "no touch" approach to diagnostic hysteroscopy without anesthesia with traditional diagnostic hysteroscopy after intracervical injection of mepivacaine hydrochloride 3%.

METHODS: A total of 130 women undergoing diagnostic hysteroscopy were included in the study and were randomized, using a computer-generated randomization list to one of two treatment groups in a ratio of 2:1. Eighty-three women underwent hysteroscopy without speculum, tenaculum, or anesthesia. Forty-seven women received intracervical anesthesia with 10 mL of 3% mepivacaine hydrochloride solution injected at two sites (3:00 and 9:00 positions) and underwent traditional hysteroscopy. Hysteroscopy was performed using a rigid 3.7-mm hysteroscope and a medium of 0.9% saline, and the image was transmitted to a screen visible to the patient. A visual analog scale (VAS) consisting of a 10-cm line was used to assess the intensity of pain experienced during and after the procedure. Overall patient satisfaction was assessed during, immediately after, 15 minutes later, and 3 days after hysteroscopy.

RESULTS: The mean pain score was significantly lower in the group without the use of speculum, tenaculum, or anesthesia (VAS1: 3.8±2.7 versus 5.34±3.23, P=.01; VAS2: 3.02±2.50 versus 4.57±3.30, P=.008). Patient satisfaction rate was similar in both groups.

CONCLUSION: Patients reported significantly less pain with the altered approach to diagnostic hysteroscopy compared with patients undergoing the traditional procedure with anesthesia. This new approach can therefore be considered as a useful hysteroscopic technique.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00319410

LEVEL OF EVIDENCE: II-1






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