Assessment of Pain Complaints and Perioperative and Delayed Complications of Hysteroscopy Performed Under Local Anesthesia—A Retrospective Analysis

Modern, small-diameter endoscopic instruments, such as resectoscopes (e.g., the GUBBINI System) and mini-hysteroscopes, are widely used in clinical practice. These tools allow endoscopic procedures to be conducted without cervical dilation, often in an outpatient setting, and under local anesthesia alone. <b>Background/Objectives</b>: The present retrospective study aimed to analyze the perioperative and delayed complications of hysteroscopy performed under local anesthesia. This study also assessed the pain experienced during hysteroscopy under local anesthesia, depending on the type of procedure performed. <b>Methods</b>: A retrospective analysis was conducted in 1945 patients who underwent hysteroscopy under local anesthesia at the Center for Hysteroscopy, Heliodor Święcicki Gynecological and Obstetrical Clinical Hospital, Karol Marcinkowski Medical University, Poznań, Poland, between January 2021 and December 2023. Hysteroscopic procedures were performed with the GUBBINI Mini Hystero-Resectoscope through a paracervical block using lignocaine. <b>Results</b>: The procedure was discontinued in 46 patients, accounting for 2.36% of all hysteroscopies. The most common reasons for procedure discontinuation were severe pain and uterine perforation, accounting for 52.8% and 13% of discontinued procedures, respectively. The complication rates were low: uterine perforation occurred in 0.3% of cases (<i>n</i> = 6), and late complications requiring readmission occurred in 0.2% (<i>n</i> = 3). The average pain intensity score for all the patients was 2 points (2.8 ± 2.14). <b>Conclusions</b>: Our study confirmed that hysteroscopy performed under local anesthesia is a safe and effective diagnostic and therapeutic method for selected uterine pathologies, noting increased risks in cases such as extensive intrauterine adhesions. The low complication rates in both the perioperative and postoperative stages indicate the high safety profile of this procedure, particularly when performed by experienced personnel using standardized, validated protocols.