title: 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: OBJECTIVE
  To assess procedural success, patient acceptability, and cost-saving potential of operative hysteroscopy using conventional equipment and local anesthetic in an outpatient clinic.
  
  
  METHODS
  Feasibility study/service evaluation (Canadian Task Force classification II-3).
  
  
  METHODS
  Outpatient (office) clinic in a large UK teaching hospital.
  
  
  METHODS
  One hundred eighteen women with diagnosed or suspected intrauterine myomas or polyps.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Obstetrics and Gynaecology Department, Cardiff and Vale University Health Board, Cardiff, Wales. Electronic address: Richard.Penketh@wales.nhs.uk.
authors.forename: Richard J A
authors.initials: RJ
authors.lastname: Penketh
authors.affiliation: Obstetrics and Gynaecology Department, Cardiff and Vale University Health Board, Cardiff, Wales.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Bruen
authors.affiliation: Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, Wales.
authors.forename: Judith
authors.initials: J
authors.lastname: White
authors.affiliation: Obstetrics and Gynaecology Department, Cardiff and Vale University Health Board, Cardiff, Wales.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Griffiths
authors.affiliation: Obstetrics and Gynaecology Department, Cardiff and Vale University Health Board, Cardiff, Wales.
authors.forename: Asmita
authors.initials: A
authors.lastname: Patwardhan
authors.affiliation: Obstetrics and Gynaecology Department, Cardiff and Vale University Health Board, Cardiff, Wales.
authors.forename: Peter
authors.initials: P
authors.lastname: Lindsay
authors.affiliation: Obstetrics and Gynaecology Department, Cardiff and Vale University Health Board, Cardiff, Wales.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hill
authors.affiliation: Cedar, Cardiff and Vale University Health Board, Cardiff Medicentre, Cardiff, Wales.
authors.forename: Grace
authors.initials: G
authors.lastname: Carolan-Rees
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000295:instrumentation / Q000379:methods; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011127:Polyps / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000779:Anesthetics, Local
keywords: Hysteroscopy; Office; Outpatient; Resection