Outpatient hysteroscopy (standard care)
All procedures were performed in the office setting using a 3.2 mm rigid
hysteroscope using normal saline as distension medium. A vaginoscopic
technique was utilised unless it failed and dilatation was necessary.
Depending on the indications and findings of the hysteroscopy,
additional procedures like pipelle biopsies, endometrial biopsies using
biopsy forceps, polypectomies, Mirena coil insertions or removals were
recorded. Intracervical local anaesthetic infiltration was administered
where necessary in the form of rescue analgesia.
Virtual reality during
hysteroscopy (intervention)
Immersive and interactive video content was delivered to patients
randomised to the virtual reality intervention using an portable,
standalone VR headset called Oculus Go with a head mounted display with
built in audio drivers. The guided relaxation experience included
viewing an 8-minute video called ‘Forest of Serenity’ commissioned by
St. Giles Hospice, developed by Holosphere and narrated by Sir David
Attenborough27. The immersive video simulated a
calming rainforest and a lake setting with animated wildlife, which
could be explored by using the headtracker. The video played was one
with minimal movement and a familiar voice to achieve maximal desired
effect. The video was played for the duration of the procedure and
replayed when the procedure exceeded 8 minutes. Patients were allowed to
stop viewing the video or remove the headset at their own discretion or
in the event of side effects.