Background:

Ambulatory hysteroscopy is a safe, reliable and cost effective alternative to hysteroscopy under general anaesthetic. The endosurgery department at Mercy Hospital for Women has been providing an outpatient hysteroscopy service since 2000.

Method:

A prospective audit of patients has been kept since 2003. Review of the audit from March 2003 to January 2014 has been conducted.

Results:

During the audit time period, 990 outpatient hysteroscopies were performed. Indications for referral included 64% abnormal uterine bleeding in premenopausal women, 22% for post menopausal bleeding and 4% for incidental finding of increased endometrial thickness in post menopausal women.

94% (921) had successful access and view. Of these cases 11% had endometrial polyps visible and required a general anaesthetic procedure for polypectomy. 1.5% had an abnormal endometrial appearance to warrant re sampling under general anaesthetic.

The remaining patients had a pipelle sample taken of which 89% returned an adequate normal sample. Of the inadequate samples, those with normal outpatient hysteroscopic findings did not require further investigation if they remained asymptomatic.

This meant that approximately only 15% of patients undergoing outpatient hysteroscopy and pipelle required a subsequent GA hysteroscopy.

There were 50 vasovagal episodes (5%) though this rate decreased with changes in practice.

Overall patient satisfaction was high with 97% of patients reporting the experience as acceptable.

Conclusion:

Outpatient hysteroscopy is a safe and acceptable alternative to general anaesthetic hysteroscopy resulting in significant savings in hospital resources.