Hysteroscopy requirements and complications

With this study, possible complications of diagnostic and surgical hysteroscopy were identified in order to define minimum safety requirements for the technique in three different healthcare settings: the physician's office, the outpatient clinic and the operating room. A literature review was conducted to compare the results in terms of feasibility and simplicity, as well as complications associated with the use of various instruments and techniques. Thanks to advances in technologies and procedures, diagnostic hysteroscopy has an excellent safety profile and is widely accepted. With the aid of minioptics (lens or fiber <4 mm in diameter), success rates have increased and hysteroscopy-associated pain has been considerably reduced. Published studies report low complication rates with minioptic hysterectomy. Surgical interventions conventionally performed on an inpatient basis (polypectomy, myoma removal) can be carried out under an outpatient or day surgery regime without the need for cervical canal dilation or anesthesia. The complications rate following hysteroscopy depends on the diameter and type of the instrument, the duration of the intervention, the extent and type of the disorder and the patient's clinical condition. Based on the study findings, the following recommendations for procedures and services can be made: diagnostic hysteroscopy with or without anesthesia performed as a simple ambulatory or gynaecologist's office procedure; surgical hysteroscopy for polypectomy, removal of myomas G0 <1 cm, synechiae and metroplasty as an ambulatory surgical procedure; surgical hysteroscopy for polypectomy, removal of myomas G0 <1 cm, synechiae and metroplasty as a safe ambulatory surgical procedure (in at-risk patients); surgical hysterectomy for myomectomy, voluminous polyps, metroplasty as a surgical procedure in day surgery.