Comparison of Operative Hysteroscopy Performed in the Operating Room Versus Outpatient Settings

Operative hysteroscopy is a key technique for the treatment of intrauterine pathologies such as endometrial polyps, submucosal fibroids, retained products of conception. Traditionally, operative hysteroscopies are performed in the operating room under general or regional anesthesia, requiring either ambulatory or inpatient hospitalization.

In recent years, advances in hysteroscopic instrumentation and procedural techniques have made it possible to perform selected operative hysteroscopies in outpatient settings (consultation office) without general or regional anesthesia. Several studies have demonstrated the feasibility, safety, and effectiveness of outpatient operative hysteroscopy, with similar success rates and complication profiles compared to procedures performed in the operating room, although some studies reported higher levels of pain during outpatient procedures (1-3) . Furthermore, cost-effectiveness studies support outpatient procedures by highlighting reduced hospital resource utilization and shorter recovery times for patients (4-6).

The HOPE study aims to evaluate this practice locally at the Centre Hospitalier Intercommunal de Créteil. This prospective monocentric observational study will include approximately 400 patients over a two-year period (July 2025 - May 2027). The primary objective is to compare the success rates of operative hysteroscopies performed in the operating room versus those performed in an outpatient setting. Secondary objectives include assessment of perioperative and postoperative pain, patient satisfaction, complication rates, and the time to return to work.

Data will be collected from medical records and patient-reported outcomes using a satisfaction questionnaire. Inclusion of patients will follow the usual care pathway, without additional interventions or follow-up beyond standard clinical practice.

• Perioperative and postoperative pain Assessed using the Visual Analogue Scale (VAS) [Срок оценки: During the procedure (if the patient is awake), immediately after the procedure, and at hospital discharge (baseline)]
• Patient satisfaction Assessed using a locally developed patient satisfaction questionnaire [Срок оценки: At hospital discharge.(assessed up to 5 days)]
• Complications including uterine perforation, hemorrhage, and postoperative infection [Срок оценки: Recorded during the procedure and immediately afterward (documented in the operative report and medical records), and up to 8 weeks postoperatively during the follow-up consultation if necessary.]
• 4. Time to return to work Measured as the number of days of sick leave prescribed and actually taken. [Срок оценки: Up to 8 weeks postoperatively.]