Comparison of vaginoscopic hysteroscopy and traditional hysteroscopy: A systematic review and meta-analysis

Background: Outpatient hysteroscopy is a safe, feasible, and optimum procedure for the diagnosis and management of intrauterine pathologies.

Objective: To determine the best approach of outpatient hysteroscopy (vaginoscopic vs traditional) in terms of pain, duration of procedure, feasibility, safety, and acceptability.

Search strategy: PubMed, Embase, Google Scholar, and Scopus were searched from January 2000 to October 2021. No filters or restrictions were applied.

Selection criteria: Randomized controlled trials comparing vaginoscopic hysteroscopy with traditional hysteroscopy in an outpatient setting.

Data collection and analysis: Two authors independently performed a comprehensive literature search and collected and extracted data. The summary effect estimate was determined using both fixed effects and random-effects models.

Results: Seven studies with 2723 patients (vaginoscopic [n = 1378] and traditional hysteroscopy [n = 1345]) were included. Vaginoscopic hysteroscopy was associated with a significant reduction in intraprocedural pain (standardized mean difference, -0.05 [95% confidence interval (CI), -0.33 to -0.23], I² = 0%), procedural time (standardized mean difference, -0.45 [95% CI, -0.76 to -0.14], I² = 82%), and fewer side effects (relative risk, 0.37 [95% CI, 0.15-0.91], I² = 0%). The procedure failure rate was similar in both approaches (relative risk, 0.97 [95% CI, 0.71-1.32], I² = 43%). Complications were mostly documented with traditional hysteroscopy.

Conclusion: Vaginoscopic hysteroscopy reduces the pain and duration compared with traditional hysteroscopy.