Narrow Caliber Office Hysteroscope

Although hysteroscopy has been available for decades, only a few gynecologists perform the procedure in an office or clinic setting. Among the presumed reasons for this lack of acceptance is the requirement for local anesthesia and subsequent dilation of the cervix for the insertion of a hysteroscope sheath, usually five millimeters in diameter. Despite such anesthesia, many patients still experience pain and discomfort. In an attempt to deal with these issues an inexpensive three millimeter diameter hysteroscope with a through lumen was designed and developed for comfortable office use, with or without either a surrounding sheath or a video camera. A multicenter pilot study was performed in 34 patients, comparing image quality, ease of viewing, requirements for anesthesia, and patient discomfort associated with the use of the new and other hysteroscopes. Because the device could almost always be inserted without dilation of the cervix and pain, discomfort and requirements for anesthesia were reduced compared with standard hysteroscopes. The angled eyepiece permitted comfortable viewing without the need for a video camera. Image size was smaller and the quality was slightly reduced compared with larger diameter hysteroscopes, but in most instances, with fluid media, visualization was adequate for diagnostic evaluation.