Outpatient hysteroscopy comes to the H.U.B!

What is the nature of the treatment pathway of a patient who is to undergo a hysteroscopy?

Normally we propose a hysteroscopy to patients with a potential pathology of the uterine cavity, such as fibriols, polyps or endometrial cancer. It can also be proposed to patients who have given birth or had a miscarriage and who have retained placenta. The point in common between all these pathologies is that they cause abnormal uterine bleeding  in the patients. That is why a hysteroscopy is a procedure carried out at the H.U.B’s Bleeding Clinic

The treatment pathway first involves an appointment with a gynaecologist who carries out a full examination and an ultrasound so as to view the uterus in its entirety. If necessary, a diagnostic hysteroscopy can be carried out during the  consultation to confirm the pathology. If the diagnostic hysteroscopy identifies an intracavitary pathology the patient returns for a second consultation for an operative hysteroscopy to treat the lesions in the uterus

Most hospitals perform an operative hysteroscopy in the operating room as the procedure requires dilation of the uterus, a painful procedure that must be done under an anaesthetic. 

The H.U.B is the third hospital in French-speaking Belgium to propose an operative hysteroscopy during a consultation and to have acquired TruClear®, a leading edge technology developed by the Medtronic company that, thanks to its small size, makes it possible to remove polyps or any other intracavitary pathology, in most cases without pain or bleeding and without anaesthetic. 

This is a truly major innovation for patients who, after this painless and rapid procedure, are rapidly able to resume their day’s activities without the least side effect.  

It should be stressed that an outpatient hysteroscopy is recommended in particular for “minor” pathologies. It is not a procedure that can be proposed to all patients. Operative hysteroscopy will be proposed to patients for whom the diagnostic hysteroscopy was painless and with a benign intracavitary pathology. Of course if these patients prefer a procedure under anaesthetic this solution remains accessible.  

This outpatient approach is also interesting for the hospital in the sense that not using the operating rooms for hysteroscopies frees them for other procedures at the Day Hospital, thereby reducing waiting times for patients.  

How do the new unit and new equipment facilitate the treatment pathway?

Everything is done at a single location, at a consultation. In the new unit we have equipped for this we have a 3D ultrasound machine and instruments to carry out diagnostic hysteroscopies and, if necessary, biopsies.  We also have a TruClear® system  that is available for outpatient operative hysteroscopies as well as virtual reality headsets for hypnosis during the procedure. Also, this unit is adjacent to the Day Hospital which means, in the case of any complication, we have rapid access to the operating room. A specialised nurse, Mme Émilie Chasseriaud, is also on hand to accompany the doctors and patients during the procedure.  
 

What expertise does the H.U.B have in this field?

The H.U.B has real expertise in this field with a team of 6 gynaecologists from the Gynaecology Clinic (myself, Dr. Soria, Dr. Vanneste and Dr. Zingarelli) and from the Fertility Clinic (Dr. Moutard and Dr. Rabattu). We are all specialised in  minimally invasive surgery and trained in the procedure. 

Together, we carry out 500 diagnostic hysteroscopies and 200 operative hysteroscopies a year.

MAR is another field in which hysteroscopy certainly has a place as patients who go to the Fertility Clinic often need an examination that includes an examination of their intrauterine cavity before commencing their MAR treatment.

The Department of Haematology  is also integrated in the Bleeding Clinic treatment pathway so as to rule out coagulation disorders as being the cause of abnormal uterine bleeding  in a patient or to treat iron deficiency anaemia caused by abundant bleeding.  

What message would you like to give to gynaecologists and GPs?  

The H.U.B now proposes a consultation that is completely integrated in outpatient hysteroscopy at the Erasmus Hospital every day with short waiting times. We can act rapidly in treating patients with:
•    Abnormal uterine bleeding during or between periods;
•    Abnormal uterine bleeding in menopausal women;
•    Iron deficiency anaemia with no evident cause identified in a blood test;

For any urgent request for an appointment or opinion for a patient, the gynaecology consultation can be contacted directly  by mail to Cons [dot] Gyn-Obs [dot] erasme [at] hubruxelles [dot] be (Cons[dot]Gyn-Obs[dot]erasme[at]hubruxelles[dot]be)