Procedures
Office procedures were performed without anesthesia. The surgeon used narrow caliber hysteroscopes, i.e., a 3.8 mm telescope with a 30-degree oblique lens and a 5-Fr working channel (compact hysteroscope; Richard Wolf GmbH, Knittlingen Germany), a 1.9 mm scope with a 3 mm diagnostic sheath (Mini-Hysteroscopes, Olympus Corporation, Hamburg, Germany) and a 1.8 mm telescope with 3.5 mm diagnostic sheaths with a 5F operative canal (Alphascope; Gynecare, division of Ethicon, Inc., Somerville, NJ). Illumination was provided by a high-intensity cold-light source via a fiberoptic lead. The uterine cavity was distended with normal saline infused by a pressure bag at a pressure of 50-100 mmHg. The vaginoscopic approach was used in all cases. Polypectomy was performed with a bipolar coaxial electrode (Gynecare VersaPoint, Ethicon Inc., Somerville, NJ). Endometrial biopsies were performed by means of a bipolar electrode, flexible scissors, or grasping forceps. All procedures were performed by two gynecologists (SB and GR).
OR procedures were performed under anesthesia and by mean of either a 3.8 mm telescope with a 30-degree oblique lens and a 5Fr working channel (compact hysteroscope; Richard Wolf GmbH, Knittlingen, Germany) or a Versapoint 2 bipolar resectoscope 24Fr (J&J, Germany). The uterine cavity was distended with a Stortz Endomat Select hysteroscopy fluid management system set to a pressure of approximately 100 mmHg.
Hysteroscopy was defined as successful only if penetration through the cervical internal os was achieved and the entire uterine cavity was visualized. Hysteroscopy was defined as failure when no penetration of the uterine cavity was achieved. It was defined as incomplete when the surgeon could not complete the procedure in one step, e.g., partial resection of an endometrial polyp for which additional office or OR procedures were usually recommended. Incomplete procedures were counted among the successful procedures.
Data were collected by reviewing the computerized medical records with a de-identified pre-prepared data sheet. All of the study patients’ computerized records were searched for follow-up information until the end of the study period.