Introduction
‘No touch’ vaginoscopy should be the standard technique for outpatient
hysteroscopy, especially where successful insertion of a vaginal
speculum is anticipated to be difficult and where blind endometrial
biopsy is not required (1).
Using this ‘no touch’ approach and not using a speculum is considered to
partly reduce the uncomfortable or painful aspect of the procedure.
However, traditionally at the end of the vaginoscopy and removal of the
scope, a speculum is passed to allow the passage of an endometrial
sampling device under direct visualisation through the external os and
blindly into the uterine cavity (2). This activity would appear to be at
odds with the claims to a ‘no touch’ procedure.
Some operators have avoided the use of a speculum by passing a H-pipelle
(50 cms long 3.1 mm diameter) through the hysteroscopic sheath (after
removal of the diagnostic scope) (3).
However, in contemporaneous outpatient clinical practice, most
diagnostic scopes in keeping with current guidelines would not be able
to accommodate the 3 mm or wider biopsy instruments (1).
Our paper describes the methodology of avoiding the passage of a
speculum but at the same time completing a blind endometrial sampling
with an Endosampler (4) at the time of ‘no touch’ vaginoscopic
investigation for abnormal uterine bleeding - the Alternative Retrieval
of Cells (ARC).