Smaller-diameter operative hysteroscopy is associated with fewer intraoperative complications without compromising efficiency: a prospective observational study
Abstract
Operative hysteroscopy is widely used for intrauterine pathologies, but the impact of hysteroscope diameter on intraoperative safety remains under-evaluated. This study compared intraoperative complications using 18 Fr versus 26 Fr operative hysteroscopes. Material and methods We conducted a prospective single-center observational study in a French university hospital. Women undergoing operative hysteroscopy for polypectomy, myomectomy, or endometrial resection between June 2023 and May 2024 were included without exclusion criteria. Procedures were performed by four senior surgeons who regularly used both systems. Hysteroscope selection (18 Fr vs 26 Fr) was at the surgeon’s discretion based on clinical and technical considerations. The primary outcome was intraoperative complications. Secondary outcomes included procedure completeness, operative time, postoperative pain, and distension fluid deficit. Results A total of 117 procedures were analyzed (18 Fr, n = 89; 26 Fr, n = 28). Intraoperative complications occurred in 11 cases (9.4%), including 9 cervical lacerations and 2 uterine perforations. Complications were less frequent with the 18 Fr hysteroscope (5.6%vs 21.4%; OR 0.22; 95% CI, 0.06–0.78). Procedure completeness (89.8%vs 85.2%; p = 0.51), operative time (18.2 ± 9.1 vs 23.0 ± 11.8 min; p = 0.09), and postoperative pain (4.5%vs 3.6%; p = 0.88) were similar. A fluid deficit ≥1500 mL occurred less frequently with 18 Fr (2.2%vs 14.3%; OR 0.14; 95% CI, 0.02–0.80). Discussion Smaller diameter hysteroscopes were associated with fewer intraoperative complications, particularly cervical trauma, without compromising procedural outcomes. Conclusion Use of an 18 Fr operative hysteroscope was associated with improved intraoperative safety without loss of effectiveness or efficiency.
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BibTeX
@article{legendre2026smallerdiameter,
title = {{Smaller-diameter operative hysteroscopy is associated with fewer intraoperative complications without compromising efficiency: a prospective observational study}},
author = {Guillaume Legendre and Camille Lesvenan and Mathieu Levaillant and Pierre-Emmanuel Bouet and Audrey Astruc},
journal = {Journal of Gynecology Obstetrics and Human Reproduction},
year = {2026},
month = aug,
doi = {10.1016/j.jogoh.2026.103259},
url = {https://hal.science/hal-05839717v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Smaller-diameter operative hysteroscopy is associated with fewer intraoperative complications without compromising efficiency: a prospective observational study
AU - Guillaume Legendre
AU - Camille Lesvenan
AU - Mathieu Levaillant
AU - Pierre-Emmanuel Bouet
AU - Audrey Astruc
PY - 2026
DA - 2026/08/25
JO - Journal of Gynecology Obstetrics and Human Reproduction
DO - 10.1016/j.jogoh.2026.103259
UR - https://hal.science/hal-05839717v1
AB - Operative hysteroscopy is widely used for intrauterine pathologies, but the impact of hysteroscope diameter on intraoperative safety remains under-evaluated. This study compared intraoperative complications using 18 Fr versus 26 Fr operative hysteroscopes. Material and methods We conducted a prospective single-center observational study in a French university hospital. Women undergoing operative hysteroscopy for polypectomy, myomectomy, or endometrial resection between June 2023 and May 2024 were included without exclusion criteria. Procedures were performed by four senior surgeons who regularly used both systems. Hysteroscope selection (18 Fr vs 26 Fr) was at the surgeon’s discretion based on clinical and technical considerations. The primary outcome was intraoperative complications. Secondary outcomes included procedure completeness, operative time, postoperative pain, and distension fluid deficit. Results A total of 117 procedures were analyzed (18 Fr, n = 89; 26 Fr, n = 28). Intraoperative complications occurred in 11 cases (9.4%), including 9 cervical lacerations and 2 uterine perforations. Complications were less frequent with the 18 Fr hysteroscope (5.6%vs 21.4%; OR 0.22; 95% CI, 0.06–0.78). Procedure completeness (89.8%vs 85.2%; p = 0.51), operative time (18.2 ± 9.1 vs 23.0 ± 11.8 min; p = 0.09), and postoperative pain (4.5%vs 3.6%; p = 0.88) were similar. A fluid deficit ≥1500 mL occurred less frequently with 18 Fr (2.2%vs 14.3%; OR 0.14; 95% CI, 0.02–0.80). Discussion Smaller diameter hysteroscopes were associated with fewer intraoperative complications, particularly cervical trauma, without compromising procedural outcomes. Conclusion Use of an 18 Fr operative hysteroscope was associated with improved intraoperative safety without loss of effectiveness or efficiency.
SN - 2468-8495
SN - 2468-7847
ER -