Getting Started

The experience of starting a hysteroscopy program may vary depending on the practice, clinic, institution or health care system, wherever it is throughout the world. Perhaps you are in a large medical center looking to migrate your operating room hysteroscopy procedures to an office or clinic space. Or perhaps you are an office practice with a dozen gynecologists, a few of whom are interested in starting an office hysteroscopy program. Others may have minimal skill at hysteroscopic surgery at all and are just trying to get their system, office or medical center, "on board" with an essential component of the care of women’s reproductive disorders. For many, performance of hysteroscopy in the office setting is daunting, with fears about patient concerns, the specter of adverse events and the reality of the cost of equipment all contributing to the challenge. Regardless of the setting, it is important to spend time to ensure that all of the relevant stakeholders are involved in the process and that there is an understanding of the regulatory, financial and staff training hurdles that must be crossed before launching the program. 
Hysteroscopy, including hysteroscopic surgery, is extremely relevant to women and the ability to perform these procedures on patients in an office setting creates an opportunity to improve both cost effectiveness and safety. Frequently missed in the analysis of cost effectiveness is the impact on the patient - an impact that can be equated to routine dental procedures. The loss of work-related income from a dental appointment is far less than what is experienced by going to a hospital or surgery center, especially if systemic anesthesia is used. The "lost opportunity" involves not only the patient, but may also affect the income of a husband, or parent, or guardian. And child care costs for a dental appointment are far less that those incurred when someone is in a hospital undergoing general anesthesia. We would submit that the vast majority of hysteroscopic procedures can be performed under minimal or local anesthesia, much like dentistry, in a safe and effective fashion. 
Regardless of the location of the program or of the complexity of cases to be treated, there are a number of elements that must be considered that contribute both to the efficacy of the procedure and the safety of the patients. These comprise adhering to local regulatory requirements, identifying an appropriate procedural space and acquiring the necessary equipment and an adequate stock of supplies. Critically important is a well-defined  method for training, or ensuring the training of medical and support staff that both supports identification of appropriate patients and the performance of hysteroscopic procedures in a safe and effective fashion. These steps can be summarized by what we refer to these as the "Core Competencies" of hysteroscopy - each surgeon and each program must master these to the extent that they are needed or anticipated for the cases to be encountered. 
Core Competencies for Hysteroscopic Programs and Teams
  1. Patient selection
  2. Patient preparation
  3. Procedure room or operating room preparation
  4. Patient positioning
  5. Uterine anesthesia
  6. Access to the cervical canal and endometrial cavity
  7. Distention of the endometrial cavity
  8. Visualization of the operative field
  9. Surgical incision, excision and hemostasis
  10. Postprocedural care
One way to assist in this process is the implementation of written protocols and guidelines for specific aspects of the hysteroscopic path that might include those related to patient preparation, administration of anesthesia, management of distending media, unanticipated surgical bleeding and a spectrum of other potential adverse events. Of course, everything must be planned and executed in a fashion that comports with existing local regulatory processes. Each of these elements is dealt with in this site and most in this section.