Is routine hysteroscopy during LLETZ a valuable additional procedure?

We aimed to critically review our experience with the value and risks of a diagnostic hysteroscopy performed in addition to LLETZ. We retrospectively included 442 womentients undergoing LLETZ and additional routine diagnostic hysteroscopy. Women for whom concomitant diagnostic hysteroscopy was somehow indicated were excluded. We focused on complications and intrauterine abnormalities detected by hysteroscopy that had not been seen on preoperative vaginal ultrasound. In 28/442 (6.3%), hysteroscopy and/or histological examination of the specimen removed by curettage revealed an abnormal intrauterine finding (benign endometrial polyps, n=20; benign cervical polyps, n=2; small leiomyomas inside the uterine cavity, n=1; septate/arcuate/unicornuate, n=5). A total of 38 surgical complications (8.6%) occurred. The two adverse events related to diagnostic hysteroscopy were uterine perforations (0.5%). In conclusion, only a few benign findings of questionable clinical relevance were discovered. Thus, we do not consider an additional routine diagnostic hysteroscopy during LLETZ beneficial for the patient.