Feasibility of resectoscopic operative hysteroscopy in a UK outpatient clinic using local anesthetic and traditional reusable equipment, with patient experiences and comparative cost analysis

Abstract

Study objective: To assess procedural success, patient acceptability, and cost-saving potential of operative hysteroscopy using conventional equipment and local anesthetic in an outpatient clinic.

Design: Feasibility study/service evaluation (Canadian Task Force classification II-3).

Setting: Outpatient (office) clinic in a large UK teaching hospital.

Patients: One hundred eighteen women with diagnosed or suspected intrauterine myomas or polyps.

Interventions: Operative hysteroscopy (122 monopolar resection procedures using 8- or 10-mm diameter rigid resectoscopes with glycine solution for uterine irrigation) with the patient under local anesthesia in an outpatient (office) clinic.

Measurements and main results: Procedural success, duration of procedure, pathologic measurements, glycine irrigant deficit, patient pain scores and satisfaction, and comparative costs were recorded. Success of outpatient procedures was 90% (110 of 122 attempted), with a significantly reduced median procedure duration compared with a surgical setting using local (-7 minutes; p = .009) or general (-12.5 minutes; p < .001) anesthetic. Glycine irrigant absorption was low (median deficit, 0 mL), and no deficit was observed in 81% of patients. Mean (SD) estimated disease volume was comparable to that of hysteroscopic resection procedures in a surgical setting (3.38 [5.09] cm(3)), and weight was 1.8 (1.84) g. Patients tolerated the procedure well and reported low pain scores (highest median periprocedure pain measurement was 1.25 of 10), and 7-day follow-up satisfaction responses were positive. Retrospective cost analysis demonstrated that operative resection in an outpatient clinic was less expensive than in a surgical setting using general anesthetic (-$1003) or local anaesthetic (-$234). Reduced staff costs were the primary reason for this saving.

Conclusions: Operative hysteroscopic resection of myomas and polyps is feasible and well tolerated by patients in an outpatient/office setting using local anaesthetic and conventional equipment. The outpatient procedure is less expensive and its duration is shorter than in a surgical setting.

Keywords: Hysteroscopy; Office; Outpatient; Resection.