Office Hysteroscopy의 임상적 유용성

고민환,이태형,김정숙,최윤영,정상훈 영남대학교 의과대학 2005 Journal of Yeungnam Medical Science Vol.22 No.1

자궁경술은 자궁강내를 직접 보고 생검하면서 수술 등을 할 수 있는 장점이 있어 부인과영역에서 진단 및 치료에 보다 더 정확하고 안전한 시술로써 인정받고 있으며 그 영역이 점차 확대되고 있다. 최근 20년간 내시경 영상과 수술기술, 수술도구의 발전으로 많은 진보가 있어 왔으며 이로 인해 office hysteroscopy가 가능하게 되었다. Office hysteroscopy는 입원하지 않고 당일 시술을 받을 수 있어 환자가 간편하고 안전하게 받을 있는 매우 유용한 술기로 여겨진다. 저자들은 1995년 9월부터 2005년 3월까지 시행한 자궁경술 140명 중 office hysteroscopy 18명을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Background: Hysteroscopy is considered to be the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different types of benign pathologies localized to those regions. The advent and evolution of endoscopic imaging and surgery during the last two decades has added new dimensions to the armamentarium of a gynecologist to combat intrauterine lesions. Office hysteroscopy is increasingly being used as a fast line investigation for abnormal uterine bleeding and other diseases involving the uterine cavity. The aim of our study is to assess the diagnostic and operative efficacy of office hysteroscopy. Materials and Methods: In our department, 140 patients underwent a hysteroscopy examination and 18 of these underwent an office based hysteroscopy examination from September 1995 to March 2005. The cases who underwent an office based hysteroscopy examination were reviewed in order to assess the clinical usefulness and significance in the management of intrauterine lesions. Results: Major indication was abnormal uterine bleeding(12 cases, 66.7%). The others were a missed IUD and infertility. The hysteroscopic findings were a normal uterine cavity(6 cases, 33.3%), lUD in situ, polyp, submucosal myoma, endometrial hyperplasia and a placenta remnant. Conclusion: Office hysteroscopy is a safe, quick and effective method for making an intrauterine evaluation. In addition, it provides immediate results, offers the capacity of direct targeted biopsies of suspicious focal lesions, and offers the direct treatment of some intrauterine conditions.

Clinical practice in office hysteroscopy

Namkung Jeong,Angela Cho,Yu-Jin Koo,Jun-Woo Ahn,Hyuntae Park,Eun Sil Lee,Sang Wook Yi,Won Duk Joo,Sang-Hoon Lee,Jae Kwan Lee,Sa Ra Lee 대한산부인과학회 2025 Obstetrics & Gynecology Science Vol.68 No.3

Hysteroscopy is particularly valuable for the diagnosis of uterine cavity abnormalities through direct visualization. The development of office hysteroscopy has expanded the range of diagnostic and surgical procedures available. These detailed guidelines include patient counseling and the selection and setting of office hysteroscopy, including room, equipment, and medical staff. Analgesia or local anesthesia is often required in selective office hysteroscopy cases. Cervical dilation and preparation using medical or mechanical methods are required for most diagnostic hysteroscopic procedures. Methods for optimizing visualization and choosing suitable distension media are important for a successful office hysteroscopy. It is crucial to adhere to guidelines to prevent complications, such as vasovagal syncope, cervical trauma, uterine perforation, fluid overload, and embolism. Vaginoscopy can be a good alternative option for alleviating pain, especially in cases where the insertion of a vaginal speculum is expected to be challenging.

자궁경시술 중 발생한 공기 색전증 1 예

권순철 ( Soon Chul Kwon ),강인구 ( In Gu Kang ),김태우 ( Tae Woo Kim ),강승철 ( Seung Chul Kang ),원석 ( Seok Won ),박정근 ( Jeong Keun Park ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.10

Complications from hysteroscopy are relatively rare events. They occur more frequently with operative hysteroscopy than with diagnostic hysteroscopy. Air embolism is a rare but devastating complication of hysteroscopy that rightly receives attention as a frightening, sudden, and potentially fatal hazard in otherwise healthy women. We experienced one case of air embolism during diagnostic hysteroscopy for abnormal uterine bleeding under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevention of catastrophic outcomes and the hysteroscopists must understand the pathophysiology of air embolism to prevent, diagnose, and manage this potentially disastrous problem effectively.

Safety and efficacy of intrauterine lidocaine compared to warm isotonic sodium chloride solution for the control of pain during office hysteroscopy: a randomized controlled trial

Amira Shoab,Amira H AbdelAziz,Hesham El-Shaer,Ahmed M Maged,Wael El-Sherbiny 대한산부인과학회 2025 Obstetrics & Gynecology Science Vol.68 No.6

Objective To compare the effectiveness of intrauterine lidocaine and warm isotonic sodium chloride solution as distension media for pain reduction during office hysteroscopy. Methods This triple-blind randomized controlled trial included 100 patients undergoing diagnostic office hysteroscopy. They were randomized into either the isotonic sodium chloride solution group, which underwent hysteroscopy using warmed isotonic sodium chloride solution as the distension medium, or the lidocaine group, which underwent hysteroscopy using 5 mL of 2% lidocaine diluted in warmed isotonic sodium chloride solution as the distension medium. The primary outcome was the pain visual analog scale score during and after the procedure. Results The pain score reported throughout the procedure (during insertion, visualization and withdrawal) and 15 minutes after the procedure was significantly lower in women in the lignocaine group compared to the other group (1.9±1.0 vs. 3.1±0.8, 1.5±0.8 vs. 2.5±0.8, 1.7±0.8 vs. 2.8±0.7, and 1.1±0.2 vs. 1.7±0.8, respectively). Regarding complications, there were no differences between the two study groups in reported vaginal bleeding (1 vs. 2) or vasovagal reaction (0 vs. 1) with no reported cases of uterine perforation or creation of false tract. Regarding side effects, there were a significantly lower number of women who experienced lower abdominal pain, nausea and headache in the lignocaine group compared to others. Conclusion The addition of lidocaine to isotonic sodium chloride solution as the distension medium during office hysteroscopy was associated with low pain scores during and after the procedure, short procedure time, reduced need for additional analgesia, high patient satisfaction, and low procedural difficulty scores.

소파술 및 자궁내시경을 위한 자궁경관 확대에 있어서 경구 미소프로스톨의 유용성

조기식 ( GS Cho ),김평국 ( PK Kim ),김정욱 ( JW Kim ),홍성일 ( SI Hong ),강영호 ( YH Kang ),김태균 ( TK Kim ) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.6

Objective: Recently, prostaglandins were used for cervical ripening and dilatation in pregnant women. However, its use in non-pregnant women is not well established. We compared pregnant versus non-pregnant woman for cervical ripening effect of oral misoprostol. Endometrial curettage and hysteroscopy are widely performed procedure in obstetrics and gynecology department. Difficulty in entering the internal os may be encountered, especially in nulliparous woman. The use of cervical priming agent is effective in reducing complications during cervical dilatation. We have used osmotic dilator[laminaria] for cervical dilatation prior to endometrial curettage and hysteroscopy. But laminaria is occasionally dangerous and uncomfortable to patient. We propose a new cervical priming agent[oral misoprostol] which is safe, cheap, comfortable and effective for cervical dilatation in both pregnant and non-pregnant woman. Methods: One hundred of patient requiring D&C and hysteroscopy were recruited for this study. The patients were received misoprostol 200μg orally 12 hours before D&C and hysteroscopy. The effect of oral misoprostol was evaluated by number of Hegar dilator at operation room. Results: The mean Hegar dilator number with resistance[H] was 9.69, without resistance[M] was 7.9. In pregnant women, H = 10.2, M = 8.3. In nonpregnant women, H = 9.18, M = 7.5. In nullipara, H = 9.76, M = 7.88. In primipara, H = 10.1, M = 7.88. In multipara, H = 9.52, M = 7.98. Of total 100 cases, four cases were difficult to perform D&C and hysteroscopy because Hegar dilator number with resistance[H] was below 8. Overall success rate was 96%. Conclusion: This study suggests that oral misoprostol is effective for cervical dilatation before curettage in both pregnant and non-pregnant women.

Virtual reality for pain relief during office hysteroscopy: a randomized controlled trial

Rania Gamal,Ahmed Zidan,Waleed Shawky,Joseph Ibrahim,Yassin Mostafa,Tarek Sabry,Amro Elhusseiny,Radwa Ali 대한산부인과학회 2025 Obstetrics & Gynecology Science Vol.68 No.5

Objective Office hysteroscopy (OH) is widely used to diagnose and manage intrauterine pathologies. However, pain remains the primary factor that contributes to OH failure. This study aimed to assess the effect of virtual reality (VR) on pain reduction during OH. Methods A prospective randomized controlled clinical trial was conducted at a university hospital between July and November 2024. The study involved 50 women undergoing OH randomly allocated to receive immersive VR videos during the procedure or standard care. The main outcome measure was self-reported intraoperative pain evaluated using a numerical rating scale. Other measures included satisfaction, duration, and success of the procedure. Results Mean pain scores were 6.16±1.86 in standard care group and 4.88±1.69 in VR group (difference, 1.28; 95% confidence interval [CI], 0.27 to 2.29; P=0.014). After adjusting for other variables, no statistically significant relationship was found between VR and severe pain (odds ratio, 0.75; 95% CI, 0.15 to 3.87; P=0.73); only severe anxiety in women and procedure duration were associated with severe pain. Conclusion Virtual reality did not significantly reduce pain severity during hysteroscopy. However, severe pain was associated with high anxiety and a longer procedure duration. These findings suggest that VR may not effectively mitigate severe pain, whereas managing anxiety and minimizing procedure time could be more effective strategies.

Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after hysteroscopy: a randomized controlled study

( Birgitta Platon ),( Sven-egron Thörn ),( Clas Mannheimer ),( Paulin Andréll ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.5

Objective To compare the time spent in the Post-Anesthesia Care Unit (PACU) and the pain-relieving effects of treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after hysteroscopy. Methods All patients who postoperatively reported a visual analogue scale (VAS) pain score of ≥3 were included in the study. TENS treatment was given with a stimulus intensity between 40 and 60 mA for 1 minute and repeated once if there was insufficient pain relief. In the opioid group, a fractionated dose of 5 mg morphine was administered. If the patient reported insufficient pain relief after the assigned treatment, the patient was reassigned to the other treatment group. Results Seventy-four women were randomized to TENS (n=38) or IV opioids (n=36) for treatment. Both groups reported significant pain relief after discharge from the PACU, with a decrease of VAS scores from 5.6 to 1.4 in the TENS group (P<0.001) and 5.1 to 1.3 in the opioid group (P<0.001). There were no significant differences between the groups. When only the responders in both groups, i.e., patients with VAS scores of <3 on respectively assigned treatments, were compared, the TENS responders (n=22) were found to have spent a significantly shorter time in the PACU (91 vs. 69 minutes, P=0.013) compared to the opioid responders (n=20). Conclusion Using TENS as first line of pain relief may reduce the need for postoperative opioids. In addition, TENS appears preferable as the first line of treatment due to its association with a shorter time spent in the PACU if the patient responds to the treatment. Trial Registration Vastra Gotalandsregionen Identifier: 211261

자궁내시경적 근종제거술 동안 발생한 저나트륨혈증

김환희,황진영,전영태,황정원,도상환,나효석 대한마취통증의학회 2009 Korean Journal of Anesthesiology Vol.57 No.5

Hysteroscopy is frequently used to assist the diagnosis and treatment of a series uterine diseases. However, complications associated with the procedure including fluid overload, hyponatremia, hypo-osmolality, hemorrhage, uterine perforation, and air embolism have been reported. The incidence of fluid overload with hyponatremia during hysteroscopic procedures has been reported to be up to 6% and it can probe fatal. Thus, early recognition of this condition and prompt intervention thereof is important to prevent adverse sequelae. Here, we report a case of hyponatremia with incidental fluid overload during hysteroscopy. We detected the signs of complication early on and were thus able to manage it promptly without any resulting adverse sequelae.

Operative hysteroscopy-assisted pregnancy termination after failed surgical abortion in missed abortion of woman with complete septate uterus

( Soomin Ryu ),( Hye Won Baek ),( Inha Lee ),( Young Bin Won ),( Heeyon Kim ),( Jae Hoon Lee ),( Bo Hyon Yun ),( Joo Hyun Park ),( Seok Kyo Seo ),( Sihyun Cho ),( Young Sik Choi ),( Byung Seok Lee ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.1

First trimester surgical abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a leftsided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.

Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation

( E. Scott Sills ),( Gianpiero D. Palermo ) 대한산부인과학회 2016 Obstetrics & Gynecology Science Vol.59 No.4

We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient’s condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.