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Sir,

We thank Dr Tsimpanakos and colleagues for their interest in our paper.1,2 We are aware of the H Pipelle as a ‘no-touch’ global endometrial sampling device; however, to our knowledge, its use in routine clinical practice is not widespread. Therefore, our comment that, ‘A vaginal speculum is also required when a global endometrial biopsy is indicated’, is true in the majority of clinics.

We agree that the ethos of ‘no-touch’ hysteroscopy should be extended to include endometrial biopsy, whether this be by utilising hysteroscopically assisted global sampling devices2 or directed biopsies.3 Furthermore, although our systematic review addresses diagnostic outpatient hysteroscopy, we already advocate a vaginoscopic approach to outpatient operative procedures, including hysteroscopic sterilisation4 and bipolar electrosurgery,5 to improve patient comfort and facilitate the manoeuvrability of instruments within the uterine cavity.

Research to explore the accuracy of new ‘no-touch’ sampling devices and the effectiveness of a vaginoscopic approach to hysteroscopic surgery compared with current practices is required.

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