The Rapid Access Hysteroscopy service means that patients can be referred for a single visit assessment which includes consultation, biopsy and hysteroscopy at the same visit. This is the first such service in New South Wales.
Hysteroscopy is the investigation of the cavity of the uterus using a telescope. Traditionally this is with a rigid hysteroscope under general anaesthetic but flexible hysteroscopes allow for the procedure to be performed without general anaesthetic and are associated with reduced pain compared to rigid hysteroscopy. Chris O’Brien Lifehouse has the only flexible hysteroscopes in Australia.
Indications for referral
Any symptoms raising suspicion of cancer of the uterus may prompt a referral. Traditionally this referral would be to a gynaecologist or gynaecological oncologist who would assess the symptoms and then arrange appropriate investigations, which often include an ultrasound and/or elective hysteroscopy at a later date.
Indications for referral for rapid access hysteroscopy include:
- Postmenopausal bleeding
- Abnormal or unexpected bleeding on tamoxifen
- Abnormalities of the endometrium on ultrasound (e.g. ‘thickened’ endometrium)
- Small endometrial polyps on ultrasound (less than 8mm)
- Insertion of mirena IUD for patients at risk of endometrial hyperplasia
- Any other indication suspicious of malignant or pre-malignant uterine abnormalities
How to refer
To refer a patient to the Rapid Access Hysteroscopy Service, GPs should visit the Refer a Patient page and use the ‘Referral to Gynaeoncology and Rapid Access Hysteroscopy’ referral form. Remember to tick the box ‘Rapid Access Hysteroscopy’ if your patient is interested in this option.
The patient will then be contacted and be offered an appointment in the next rapid access hysteroscopy clinic (every Thursday). She may still choose the standard referral pathway if she prefers.
Once booked into the clinic we will arrange for a transvaginal ultrasound to be performed on the same day just prior to the clinic visit (if not already undertaken).
At clinic a standard consultation will be conducted and if still suitable the patient will then be offered a hysteroscopy in the clinic at the same visit. Hysteroscopy is performed in our fully equipped procedure room usually under cervical local anaesthetic although this is not always necessary. An endometrial biopsy will usually be performed during the same procedure. If a small endometrial polyp is present then it can be removed during the same procedure.
If the hysteroscopy is normal then the patient may be discharged from the clinic with a written or telephone follow up for results, and otherwise will be invited back for a results visit the next week. Therefore it is possible that the patient will only ever have one visit to the clinic, although they would be asked to re-attend if symptoms reoccur.
What are the advantages over the traditional referral pathway?
The main advantage of the rapid access clinic is that it should minimise clinic visits and deliver information to the patient at the same visit. A standard pathway usually requires a consultation visit, inpatient hysteroscopy visit and then a results visit (three visits). Under the rapid access pathway most attendances would have a ‘one-stop visit’ with the hysteroscopy outcome delivered to the patient during the procedure (pending biopsy confirmation).
A further advantage is the avoidance of general anaesthesia in the majority of instances. Data from the United Kingdom suggests that outpatient hysteroscopy is successful in more than 80 per cent of patients, removing the need for a general anaesthetic procedure. Furthermore, outpatient hysteroscopy is associated with more rapid mobilisation and less time off work (0.8 versus 3.3 days) compared to general anaesthetic hysteroscopy.
If you need further assistance:
If you have any questions regarding the service, please feel free to contact A/Prof Sam Saidi directly on firstname.lastname@example.org or (02) 8514 0258