<div></div><div>We are all likely to need a blood test, a biopsy or wind up on the wrong
end of an endoscope. We know that the experience is not going to be
pleasant. Many of us will revert to techniques to divert attention away
from painful stimuli, such as counting forwards or backwards in our
heads, deep breathing, imagining tranquil places or listening to music.
But the paper published in this issue of BJOG by (Neo D et al, BJOG
2020; xxxx) shows us how we can distract patients in a more
sophisticated way, using virtual reality (VR) technology. The procedure
the research groups chose to investigate was outpatient hysteroscopy.</div><div>Outpatient hysteroscopy is a key part of contemporary gynaecological
practice. The procedure is acceptable to the vast majority of women, but
most will experience some pain and, in a small proportion of women, this
can be severe (Smith P, et al, BJOG 2019;126:891-899). Thus, outpatient
hysteroscopy, being common and potentially painful, is a good health
technology to evaluate the impact of VR technology on patient experience</div><div>Deo N et al, conducted a randomised trial of 40 women undergoing
outpatient hysteroscopy for a variety of indications and simple
therapeutic procedures were allowed such as biopsy, polypectomy and
insertion of a Mirena<sup>®</sup> device. Women were allocated to
standard care or “immersive and interactive video content using a
portable, standalone VR headset”. The latter delivered a “guided
relaxation experience” which included viewing an 8-minute, narrated
video depicting “a calming rainforest and lake setting with animated
wildlife, which could be explored by using the “head-tracker”.</div><div>The preliminary results are impressive. Reduction in peri-procedural
pain was statistically significant but more importantly the effect size
of a 2cm (20%) difference on a 10cm visual analogue scale must be
clinically significant. Reduction in anxiety scores were of a similar
magnitude. However, the average hysteroscopy procedure duration was less
than 4 minutes, which begs the question, is the cost, time and hassle of
setting up and using VR technology worth it? Moreover, 16% of eligible
women did not want to use the VR technology because of prior adverse
experiences, anxiety or state a preference to see the procedure or use
their own distraction media.</div><div>No-one is going to change clinical practice on a sample of 40, but many
practitioners will be energised to conduct larger scale trials to
confirm these provisional results and to analyse more deeply the impact
of immersive VR technology on reducing pain and anxiety associated with
outpatient hysteroscopy. Future work should look at the type of VR
technology, the context where it is deployed for what kind of procedure.
The optimal VR programme may vary according to patient characteristics,
the type of surgery and its duration. VR technology should be tested in
more painful gynaecological interventions such as endometrial ablation,
cervical biopsy and transvaginal egg collection. Moreover, the
prospective benefit of VR need not be restricted to gynaecological
practice but should be evaluated in a whole host of ambulatory
procedures involving conscious patients.</div><div><b>No disclosures:</b> A completed disclosure of interest form is
available to view online as supporting information.</div>