Outpatient theatreOutpatient Procedures

We offer a number of minor procedures which can be safely performed in outpatient environment without the use of general anaesthesia:

Endometrial biopsy is a simple procedure which is sometimes used to investigate possible causes of abnormal uterine bleeding. A small sample of the uterine lining is obtained and sent for histological examination, which is often helpful to advise women on the best treatment of their symptoms.

Saline infusion sonohysterography (SIS) is a procedure which involves instillation of a small amount of fluid into the uterine cavity. This improves quality of ultrasound imaging of the uterus and facilitates the diagnosis of minor abnormalities of the uterine cavity such as endometrial polyps or intra-uterine adhesions. The procedure is sometimes used when a conclusive diagnosis cannot be reached on a standard ultrasound examination. Some fertility specialists routinely request SIS in women considering complex fertility treatment such as IVF.

Removal of small cervical polyps, which are typically detected during a cervical smear test, can be performed in the outpatient clinic. Ultrasound examination is always performed first to assess the size of polyps and the site of attachment to maximise the success and safety of the procedure.

Insertion of intrauterine contraceptive device (IUCD). In order to increase the success and safety of IUCD insertion we always perform these procedures under ultrasound guidance. We are able to offer a choice of both standard Copper containing devices and hormone releasing Mirena coil. We offer a safe and effective outpatient technique of removing coils with lost threads without the need for hospital admission and general anaesthesia.

Fallopian tube patency testing (HyCoSy). Approximately 25% of women with fertility problems will have either a blockage or distortion of their Fallopian tubes which will could make conception difficult or increase the risk of ectopic pregnancy. Conventionally, the assessment of Fallopian tube function was performed using x-ray (hysterosalpingography - HSG) or at surgery (laparoscopy and dye test). A more recent method to assess tubal patency using ultrasound (HyCoSy – hysterosalpingography) has been shown to be as good as a laparoscopy and dye, less painful than an HSG. Our Centre is one of a very few in the UK who are able to offer three-dimensional HyCoSy to our patients. The use of three-dimensional technology increases diagnostic accuracy and shortens the time of examination by enabling storage, review and re-examination of all images.

Aspiration of simple ovarian cysts under ultrasound guidance is sometimes necessary in women undergoing fertility treatment. This can be done in the outpatient clinic using either the transabdominal or transvaginal routes. Some women develop chronic pelvic pain due to accumulation of fluid within thick pelvic adhesions, which occasionally develop after previous extensive pelvic surgery. In these women symptoms can only be relived by intermitted fluid aspiration, which we are able to offer in our clinic.

Surgical treatment of miscarriage under local anaesthesia*. Miscarriage is the most common complication of early pregnancy and it is estimated that every one in six pregnancies is lost through miscarriage. Surgical removal of pregnancy tissue retained within the uterine cavity after miscarriage is often required to facilitate women’s’ recovery and to restore their normal menstrual cycles.  These procedures are routinely performed under general anaesthesia.  Our consultants are some of the very few in the UK who are trained to perform these procedures under local anaesthesia.  Procedures under local anaesthesia are safer and women recover faster compared to the procedures performed under general anaesthetic.  As local procedures are performed in the outpatient operating theatre the costs are much lower compared to operations under general anaesthetic which require admission to hospital.

Outpatient hysteroscopy* is a surgical procedure which involves insertion of a small telescope into the uterine cavity.  In the past this procedure was often used to diagnose abnormalities of the uterine cavity such as polyps or small fibroids.  With recent advances in ultrasound diagnosis hysteroscopy is used less for the diagnosis and more for the treatment of abnormalities of the uterine cavity detected on scans.  Modern hysteroscopes are very thin, which makes the procedure easier to tolerate.  In many cases the procedure can be performed in the outpatient setting under local anaesthesia, which increases the safety of the procedure and reduces the costs.

* These procedures are performed on private basis in the outpatient theatre at University College Hospital, London