Hysteroscopic adhesiolysis under conscious sedation and local anesthesia in an outpatient setting: A large retrospective study.

OBJECTIVE

This study reviews the outcome of a series of hysteroscopic adhesiolysis (HA) in an outpatient setting.

MATERIALS AND

METHODS

This is a retrospective case series study performed at a fertility center. A total of 1073 women with mild, moderate, or severe intrauterine adhesions (IUAs) underwent HA between January 2011 and December 2023. Fourteen women who underwent HA under regional or general anesthesia were excluded. The remaining 1059 women were scheduled for HA in an outpatient setting under conscious sedation and local anesthesia. At the end of the HA procedure, within 1 min, the severity of discomfort or pain was assessed using the visual analogue scale (VAS).

RESULTS

Hysteroscopic adhesiolysis was successfully performed under conscious sedation and local anesthesia in 1051 (97.9%) women during the study period. The mean age of the participants was 38.2 ± 5.25 years. The mean VAS score was 1.46 ± 1.18. In women with mild, moderate, and severe IUAs, the scores were 0.77, 1.42, and 2.49, respectively. In nine (0.9%) women, a uterine perforation occurred. Of the 618 (58.8%) women with complete follow-up, 140 (27.7%) conceived. In women with mild, moderate, and severe IUAs, the miscarriage rates were, respectively, 15.9%, 19.0%, and 60%. The live birth rates were 16.9%, 9.5%, and 1.4%, respectively.

CONCLUSION

Hysteroscopic adhesiolysis in an outpatient setting under conscious sedation and local anesthesia appears feasible and is well tolerated, with a low complication rate. Given the retrospective nature of the study, the results should be interpreted with caution. Future studies are needed to evaluate HA under conscious sedation and local anesthesia, including long-term fertility and reproductive outcomes.