Physicians Urged to Adopt Office Hysteroscopy


SANTA FE, N.M. — One hundred thirty-five years after Pantaleoni performed the first hysteroscopy, Stephen M. Cohen, M.D., urged physicians to move the diagnostic procedure from the operating room to the office.

New technology makes office hysteroscopy more effective, less expensive, safer, and easier to perform than invasive diagnostic alternatives, according to Dr. Cohen, chief of the division of gynecology and director of women's minimal access surgery at Albany (N.Y.) Medical College. Fertility investigations and some simple surgical procedures can be done in the office with hysteroscopy, he said at a conference on gynecologic surgery sponsored by Omnia Education.

“I think all of us in the next 5 years will be doing hysteroscopic sterilizations in the office,” Dr. Cohen said, citing avoidance of intraabdominal complications and general anesthesia with hysteroscopy. “The laparoscopic sterilization will be a procedure of the past or used in very selected cases.”

Office hysteroscopy is especially useful for direct diagnosis of the cause of abnormal uterine bleeding, according to Dr. Cohen, who has served on the speakers' bureau for Karl Storz, which manufactures hysteroscopes.

“So many patients have submucous fibroids,” he said. “You can put the scope in and see those. … You can see endometrial polyps and take them out if you like.”

Dr. Cohen described the basic equipment for office hysteroscopy as relatively simple—a scope, a light source, a camera, and a monitor. He said they could be purchased separately or in a compact combination unit for about $15,000. Auxiliary instruments would include scissors, biopsy forceps, and graspers.

If the physician is concerned about doing enough procedures to cover the expense, Dr. Cohen suggested renting a unit for one or two afternoons a month when office hysteroscopies are scheduled. “If you have it in your office, you are going to use it much more,” he said.

Newer scopes allow the physician to see the entire uterus upon entering the cervix, according to Dr. Cohen. He cited the 3.5-mm Bettocchi scope as giving a “crystal clear view” and the Versascope for being disposable. Some physicians prefer flexible scopes, but they are somewhat more expensive and not absolutely necessary for office hysteroscopy, Dr. Cohen said.

Physicians also may want a printer so they can record exactly what they saw in the patient's chart. “It's also good if you get lots of patient referrals,” Dr. Cohen said. “You send printouts back to the referring physician.”

Dr. Cohen said he does office hysteroscopy entirely with local anesthesia, which is reimbursed by insurance companies and allows patients to watch in real time on the television screen.

The only painful part, Dr. Cohen said, comes at the end of the procedure when he uses a Pipelle to biopsy tissue. He saves this for last so as not to disturb the endometrium, which he also can measure during hysteroscopy.

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