Advances in Outpatient Hysteroscopy

Abstract

Hysteroscopy is a gynaecological procedure that has developed into an important tool to identify endometrial abnormality. It offers direct examination of the uterine cavity and tubal ostia and offers the option of performing targeted biopsy of suspected lesions that can be missed by blind procedures. In a large number of cases, the intrauterine lesions can be diagnosed and treated at the same setting as one step approach (“see and treat”). For example, endometrial polyps can be identified and removed; intrauterine adhesions may be divided in the office owing to the practicability of operative saline hysteroscopy, vaginoscopic approach and the convenience of miniature hysteroscopes. There is decent evidence that hysteroscopy in the outpatient clinic setting is preferred by the patients, associated with low risk of complications, quicker recovery time and reduced cost. Technological advances have led to development of high definition miniature hysteroscopes without negotiating optical performance, and hence making hysteroscopy an ingenuous, safe and trusted office procedure. Recent advances such as bipolar electrosurgery, endometrial ablation devices, morcellators and tissue retrieval system has transformed the surgical technique. This modernization of hysteroscopy completely revolutionised the approach to the management of intrauterine pathologies, moving from a blind procedure under general anaesthesia to directly visualised procedure under no or local anaesthesia, offering diagnostic as well as therapeutic procedures that should be at the disposal of every modern gynaecologist.