• Project led by University Hospital of Wales.
  • Focused on an outpatient clinic for women with menstrual problems or post-menopausal bleeding.
  • Aimed to improve patient experience, reduce waiting times and make cost savings by providing an alternative to operative hysteroscopy under general anaesthetic in day case theatre.
  • Offered operative hysteroscopy under local anaesthetic in a one-stop outpatient clinic, with some patients managed on a see-and-treat basis.

The University Hospital of Wales team investigated the impact and effectiveness of carrying out operative hysteroscopy under local anaesthetic in an outpatient clinic, rather than under general anaesthetic in day case theatre. 

Some hospitals were already offering operative hysteroscopy in an outpatient environment, using small bipolar diathermy devices. However, this approach has disadvantages including a slow rate of tissue removal and limits to the size of polyp that can be treated. The electrodes used in the devices are also expensive. The team wanted to explore the potential for making conventional operative hysteroscopy using a resectoscope available in an outpatient setting.

The aim of the project was to:

  • reduce waiting times and enable some patients to be managed on a see-and-treat basis
  • improve patient experience by causing less social disruption and less stress for patients and families
  • reduce the overall cost of managing each patient by avoiding theatre
  • free up valuable theatre space for other procedures.


The team assessed the effectiveness, patient accessibility and comparative health economics of the initiative. They anticipated the cost savings to be in the region of £15,000-£20,000 a year.

Further reading

Learning report

Shine: Improving the value of local healthcare services

February 2014

Successes and lessons from the first two rounds of the Health Foundation’s Shine programme: annual...

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