8. Versapoint:fibroids comparison general/local anaesthesia none/local general number: 37 14 type 0 19 (51%) 5 (36%) type I 16 (43%) 7 (50%) type II 2 (6%) 2 (14%) M Vleugels Gyn.Endoscopy 2001 10 Hysteroscopic procedures in the office
9. Versapoint: polyp size / operation time M Vleugels Gyn.Endoscopy 2001 10 Hysteroscopic procedures in the office
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11. Versapoint: results knowing the specific characteristics = small electrodes, ACCEPTABLE OPERATION TIME 30-45 MIN ???? FIBROID <2CM POLYP <2CM HOW MUCH OF THE PATHOLOGY CAN BE OPERATED WITH THIS ELECTRODE ON THE OFFICE? Hysteroscopic procedures in the office
12. Retrospective analysis 2yrs surgery; 92% of all FIBROIDS TYPE 0 OR TYPE I 47% of all FIBROIDS TYPE 0 84% of all FIBROIDS SMALLER THAN 3 CM 95% of all POLYPS SMALLER THAN 4 CM 70 - 80% can be operated in the office Hysteroscopic procedures in the office How much pathology can be operated in the office?
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15. Versapoint on the OPD "painting like an artist" Trics for removal fibroid
27. Hysteroscopic procedures in the office Can this procedure done on the OPD without any anaesthesia? which method? * procedure time? * pain experience? * placement failure rate * patient satisfaction? ** control after 3 months? *** * Study A n=173; ** study B n=273 *** study C n=160; all studies submitted
28. Flowchart essure sterilisation Intake informed consent gyn examin ultrasound data recording Planning < CD 10 Premedication procedure OPDepartm. Data recording pain score list Ultrasound TVS HSG 1-2-5 followup T=0 T=12wks T=12 wks Hysteroscopic procedures in the office
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31. Evaluation of pain (Visual Analoque Score; 0-10 ): average 2,5 ±2,5 (0-8) median 2,0 two patients got local anaesthesia ; 2/900 Average amongst nulli; 5.2! Dutch experience; Results 2 first clinics Hysteroscopic procedures in the office
32. Hysteroscopic procedures in the office Dutch experience; First 273 patients procedure time introduction of scope till removal
33. Averaged Procedure time related to parity; Multiparae; 10.3 minutes Nulliparae; 15.3 minutes Procedure time related to placement failure rate; Succes placement; 9.8 minutes Failure placement; 24!! minutes Hysteroscopic procedures in the office procedure time Multicenter data netherlands n=1021 21 clinics in 2005
34. Crude failure rate; 7.4% True failure rate=after exclusion Asherman 5.3% Failure rate related to parity (trainings clinic n=297 2002-2004) failure rate nulliparae 32% failure rate multiparae 5.1% Failure rate Multicenter data netherlands n=1021 21 clinics in 2005 Hysteroscopic procedures in the office
35. How do we control the effect? X ray to see whether the device is in abdomen? In the uterus? HSG to prove occlusion of the tubes?? Hysteroscopic procedures in the office
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