Office vs. Operating Room Hysteroscopy for Intrauterine Pathology: A Systematic Review of Clinical and Patient-Centered Outcomes

This systematic review, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluates the comparative effectiveness, safety, and patient-centered outcomes of office-based hysteroscopy (OH) versus operating room-based hysteroscopy (ORH) for intrauterine pathologies. Drawing from 10 studies published between 2016 and 2025, the review synthesizes quantitative pooled outcomes as well as narrative findings. Meta-analytic data revealed a pooled OH procedure completion rate of 94.9% (95% CI: 91.8-97.2) and a low complication rate of 0.6% (95% CI: 0.1-1.4), with negligible heterogeneity in pain scores (pooled visual analog score (VAS) 3.55; 95% CI: 3.38-3.72). Narrative synthesis showed OH to be consistently associated with high patient satisfaction, shorter procedure times, reduced need for anesthesia, and favorable cost-effectiveness. In contrast, ORH remained vital for complex cases but incurred higher costs and longer recovery due to anesthesia and surgical protocols. Across diverse global populations, OH demonstrated equivalent diagnostic yield for common pathologies such as polyps, fibroids, adhesions, and hyperplasia. Technological advancements in miniaturized hysteroscopic equipment and vaginoscopic techniques have significantly contributed to the success of OH, even in high-risk or postmenopausal patients. Despite some heterogeneity in study design and operator expertise, the data collectively support OH as a clinically effective and patient-preferred modality in suitable cases.