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).