Hysteroscopic training guidelines. The ad hoc committee on hysteroscopic training guidelines of the American Association of Gynecologic Laparoscopists.
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Female↗
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Hysteroscopic fluid monitoring guidelines. The ad hoc committee on hysteroscopic training guidelines of the American Association of Gynecologic Laparoscopists.
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Female↗
Hysteroscopic platelet-rich plasma and medically assisted reproduction outcomes: a systematic review and SWOT analysis.
BACKGROUND: Platelet-rich plasma (PRP) has been proposed as an adjuvant treatment in reproductive medicine. While most evidence refers to blind intrauterine instillation, subendometrial administration under hysteroscopic guidance allows targeted delivery under direct visualisation. This systematic review aimed to synthesise the available evidence on hysteroscopic PRP administration and its impact on clinical medically assisted reproduction (MAR) outcomes. METHODS: A systematic search was conducted from inception to December 2025 across major databases. Studies were included if they evaluated hysteroscopic PRP administration in women undergoing MAR, comparing reproductive outcomes between treated and control groups. RESULTS: Out of 142 records, 3 studies met the inclusion criteria. Study populations were heterogeneous and included women with refractory thin endometrium and/or a history of implantation failure. Hysteroscopic PRP administration protocols varied in timing, technique, and dosage. In a prospective case-control study, hysteroscopic intraendometrial PRP injection at a depth of 2-3 mm in the four uterine walls, using an ovum aspiration needle, on days 11-13 of the cycle prior to euploid frozen embryo transfer (ET), was associated with higher implantation (IR), clinical pregnancy (CPR), and live birth rates (LBR) compared with standard therapy. Conversely, no significant differences in CPR, miscarriage rate, or LBR were observed in an observational study evaluating a single intraendometrial PRP injection (35-40 mL, 2-3 mm depth), administered via endoscopic needle on days 6-8 of the menstrual cycle preceding frozen ET, alone or after electrical impulse therapy. A randomised controlled trial in women undergoing intrauterine insemination reported a significant improvement in CPR following hysteroscopic subendometrial PRP instillation in the four uterine walls (1.0 mL each). CONCLUSIONS: Current literature on hysteroscopic PRP administration in reproductive medicine is limited, and robust conclusions cannot yet be drawn. Well-designed randomised controlled trials with standardised protocols are needed to clarify its clinical role.
Humans↗
Gamete intrafallopian transfer: prospective randomized comparison between hysteroscopic and laparoscopic transfer techniques.
OBJECTIVE: To test the efficiency and overall acceptability of hysteroscopic GIFT when compared with laparoscopic GIFT. DESIGN: We performed a randomized comparison between these techniques as regards pregnancy rate (PR), implantation rate, miscarriage rate, and ectopic pregnancy rate (ectopic PR). SETTING: All patients were enrolled for GIFT procedures in our Reproductive Medicine Unit. PATIENTS: We enrolled 133 patients showing documented tubal patency at a previous diagnostic laparoscopy. INTERVENTIONS: Gonadotropin-releasing hormone analog and FSH were administered to induce superovulation in all patients, who were then randomized for hysteroscopic GIFT or laparoscopic GIFT. Laparoscopic GIFT was performed under general anesthesia while, during hysteroscopic GIFT, oocyte retrievals were transvaginal ultrasound guided and transfers were performed by cannulating tubal ostia after hysteroscopic visualization. MAIN OUTCOME MEASURE: The efficacy was evaluated comparing PR, implantation rate, miscarriage rate, and ectopic PR. RESULTS: Pregnancy rate and implantation rate of hysteroscopic GIFT procedures (29.8% and 9%, respectively) are not significantly different from those obtained with laparoscopic GIFT (43.3% and 14%). CONCLUSIONS: Hysteroscopic GIFT is safe and easy and quick to perform. Moreover, it does not require hospital admission, general anesthesia, or the operating theater, reducing costs and assuring advantages in terms of low psychophysical involvement and repeatability.
Adult↗
Complications of hysteroscopic surgery: predicting patients at risk.
OBJECTIVE: To determine the frequency of operative complications and whether they can be predicted by specific patient characteristics or type of hysteroscopic procedure. METHODS: We collected demographic and medical history information on 925 women who had hysteroscopies from 1995 through 1996. We compared differences in rates of operative complications of specific hysteroscopic procedures. Operative complications were defined as uterine perforation, excessive glycine absorption (1 L or more), hyponatremia, hemorrhage (500 mL or more), bowel or bladder injury, inability to dilate the cervix, and procedure-related hospital admissions. RESULTS: Operative complications occurred in 25 (2.7%) of 925 hysteroscopies. Excessive fluid absorption was the most frequent complication. Hysteroscopic myomectomy and resection of uterine septum were associated with greater odds of complications (odds ratio [OR] 7.4, 95% confidence interval [CI] 3.3, 16.6 and OR 4.0, 95% CI 0.9, 19.6, respectively). Hysteroscopic polypectomy and endometrial ablation were associated with lower odds of complications (OR 0.1, 95% CI 0.0, 0.7 and OR 0.4, 95% CI 0.1, 3.3, respectively). Hysteroscopies done by reproductive endocrinologists and preoperative GnRH agonist therapy were associated with 4-7 times higher odds for operative complications. CONCLUSION: Complications during hysteroscopic surgery are rare. Among hysteroscopic procedures, myomectomies and resections of uterine septa have significantly higher rates of complications, especially excessive fluid absorption. Meticulous fluid management might limit the number of serious complications of these higher-risk procedures.
Adult↗
Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women.
OBJECTIVE: To compare reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility to outcomes in infertile couples with normal hysteroscopic findings. METHODS: Women with diagnoses of infertility who had hysteroscopic evaluations by a single surgeon between 1975 and 1996 were sent a routine follow-up questionnaire regarding their reproductive histories. All 92 subjects who were located responded to the questionnaire, and 78 met inclusion criteria: age under 45 years, at least 12 months of infertility, and at least 18 months of follow-up with attempts to conceive, including in vitro fertilization in women with bilateral tubal occlusion. RESULTS: Of the 78 subjects, 36 had myomectomies, 23 had polypectomies, and 19 had normal cavities. Among the three groups, there were no significant differences in age, type of infertility, length of infertility, or follow-up after the procedure. Polypectomy subjects had significantly higher pregnancy and live birth rates than women with normal cavities. Women who had myomectomies larger than 2 cm had significantly higher pregnancy and live birth rates, achieving statistical significance at a myoma size of 3 cm or greater for live births. Spontaneous abortion rates among first pregnancies after myomectomy, polypectomy, or normal study were similar: 31.5%, 27.7%, and 37.5%, respectively. CONCLUSION: Both hysteroscopic polypectomy and hysteroscopic myomectomy appeared to enhance fertility compared with infertile women with normal cavities. Despite concern that hysteroscopic resection of a large myoma might ablate a large surface area of the endometrial cavity, the reproductive benefit appears greater than the risk.
Adult↗
Pregnancy rates following hysteroscopic polypectomy, myomectomy, and a normal cavity in infertile patients.
Objective: To assess the reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility when compared to infertile couples with a normal cavity at hysteroscopy.Material and Methods: All patients with a diagnosis of infertility who underwent hysteroscopic evaluation by a single surgeon between 1975 and 1996 were sent a questionnaire as routine follow-up regarding their reproductive history. All 100 subjects who were located responded to the questionnaire, and 78 subjects met the inclusion criteria; age <45 years, 12 months of infertility, and 18 months of follow-up with attempts to conceive including in vitro fertilization in patients with bilateral tubal occlusion.Results: Of the 78 subjects, 36 had undergone a myomectomy, 23 a polypectomy, and 19 had a normal cavity. Among the three groups there was no significant difference in their ages, types of infertility, length of infertility, or follow-up after the procedure. Using the Cox proportional hazard model, and adjusting for age, polypectomy patients had a significantly higher pregnancy rate (RR 3.89, P <.01) and a higher live birth rate (RR 2.42, P =.06) than patients with a normal cavity. Patients who had undergone a myomectomy also had a higher pregnancy rate (RR 2.02, P =.11) and live birth rate, but this did not achieve statistical significance. Pregnancy following a hysteroscopic myomectomy was associated with a larger fibroid resection (3.15 cm vs 2.5 cm P =.05). The spontaneous abortion rate following the myomectomy, polypectomy, or a normal study was equivalent, 28.1%, 23.1%, and 29.2%, respectively.Conclusions: Both hysteroscopic polypectomy and hysteroscopic myomectomy appear to enhance fertility when compared to infertile patients with a normal cavity. Despite concern that hysteroscopic resection of a large myoma may ablate a large surface area of the endometrial cavity, patients with larger myomas were more likely to conceive following resection.
Journal Article↗
Hysteroscopic incision of the septate uterus: scissors versus resectoscope.
Out of a total of 81 women who underwent hysteroscopic incision of symptomatic septate uteri during a 5-year period, 70 were analysed with respect to reproductive outcome. Division of the septum was performed with hysteroscopic scissors in 17 patients and by means of the resectoscope in 53. Pre-operative indications included infertility, repetitive pregnancy losses, abnormal uterine bleeding and intractable dysmenorrhoea. There were a total of 51 pregnancies after a mean period of 9.3 months following hysteroscopic metroplasty, of which 29 (56.8%) were carried to term, 12 (23.5%) were spontaneous abortions, and 10 (19.6%) are in progress. The post-treatment pregnancy success rate was 73%. The number of spontaneous abortions, pregnancies to term and mean time between surgery and conception was similar in both groups. There were three cases of perforation in the group of excision with hysteroscopic scissors and a case of pulmonary oedema in the group of the resectoscope. Although different advantages are provided by each technique, and more pregnancies were established using scissors, it seems that operator experience is a major consideration in performing these therapeutic hysteroscopic operations.
Adult↗
GnRH agonist analogs and hysteroscopic resection of myomas.
OBJECTIVES: The purpose of this study was to evaluate the effects of pretreatment with GnRH analogs and hysteroscopic resection of submucous myomas previously deemed to be contraindicated for this approach. METHODS: Twenty-five patients were included in this study. Patients were assessed by ultrasonography and diagnostic hysteroscopy. They were treated with depot GnRH analogs for 3 months and then scheduled for hysteroscopic surgery. RESULTS: After GnRH therapy the diameter was 61 +/- 10% of the initial diameter. In one patient, therapy was almost ineffective. Hysteroscopic surgery was possible in all 25 patients. Seven patients presented an intramural myoma that was not possible to remove entirely during the first attempt. After dessication and 2 supplementary months of GnRH analog therapy, a second surgical attempt was successful in complete removal of the tumor in all except one case. In one patient hysterectomy 15 days after hysteroscopic surgery was necessary for incoercible bleeding due to a deep adenomiosis. CONCLUSIONS: A combined medical and surgical approach seems to reduce the limit of hysteroscopic surgery and avoid open myomectomy or hysterectomy in a well selected group of patients.
Chemotherapy, Adjuvant↗
A cost comparison of hysterectomy and hysteroscopic surgery for the treatment of menorrhagia.
OBJECTIVES: To estimate and compare the costs of treating women with menorrhagia by hysterectomy or hysteroscopic surgery, in the form of transcervical resection of the endometrium (TCRE) or endometrial laser ablation (ELA). STUDY DESIGN: Randomised controlled trial set in the gynaecological department of a large British teaching hospital. Under usual circumstances, 204 women who would have undergone hysterectomy for menorrhagia were randomly allocated to either hysterectomy (n = 99) or hysteroscopic surgery in the form of TCRE (n = 52) or ELA (n = 53). National Health Service (NHS) costs and costs to patients per patient occurring up to 1 year following surgery were estimated. Theatre times and length of hospital stay were recorded during the trial. Costs were obtained from the health board finance department and relevant suppliers of technical equipment. One year after treatment patients completed questionnaires on personal costs incurred. RESULTS: The NHS costs of treating women with hysteroscopic surgery were 24% (TCRE) or 20% (ELA) less than treating women by hysterectomy (1001 pounds/1046 pounds vs. 1315 pounds). On average, women undergoing hysteroscopic surgery incurred 71% less costs to themselves than those who underwent hysterectomy (21 pounds vs. 73.40 pounds). CONCLUSIONS: Hysteroscopic endometrial ablation incurs less costs than hysterectomy both to the National Health Service and to women alike, up to 1 year after surgery.
Costs and Cost Analysis↗
Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment.
STUDY OBJECTIVE: To evaluate reproductive performance in women with a confirmed uterine anomaly treated by abdominal or hysteroscopic metroplasty, or by no surgical procedure. DESIGN: Retrospective study. SETTING: A university hospital. PATIENTS: Four hundred four women with uterine anomaly, of whom 247 had complete or partial septate uterus or partial bicornuate uterus. INTERVENTIONS: Hysteroscopic metroplasty was performed in 32 patients with septate or subseptate uterus. Twenty women underwent abdominal metroplasty (Jones or Tompkins procedure) and 140 had no operative treatment. MEASUREMENTS AND MAIN RESULTS: Fetal survival improved from 13% to 91% after hysteroscopic metroplasty and from 3% to 86% after the abdominal procedure. A living child was born in 67% of 264 pregnancies in 116 women with septate uterus with no surgical treatment. When 19 patients with hysteroscopic metroplasty were matched by age, gravidity, and type of uterine anomaly with 19 women not subjected to metroplasty, the rates were 86% and 68%, respectively (p = 0.089). CONCLUSIONS: Hysteroscopic metroplasty has replaced abdominal metroplasty in the treatment of septate uterus. It improves the fetal survival rate in women with repeated miscarriage. It does not enhance pregnancy rates in infertile women with septate uterus, but as a minimally invasive uterine repair, it may be carried out before assisted reproduction. Pregnancy in the septate uterus can also progress without any surgical treatment. Metroplasty seems to prevent breech delivery and to decrease the cesarean section rate, which are potential benefits.
Abortion, Habitual↗
Narrow Caliber Office Hysteroscope
Although hysteroscopy has been available for decades, only a few gynecologists perform the procedure in an office or clinic setting. Among the presumed reasons for this lack of acceptance is the requirement for local anesthesia and subsequent dilation of the cervix for the insertion of a hysteroscope sheath, usually five millimeters in diameter. Despite such anesthesia, many patients still experience pain and discomfort. In an attempt to deal with these issues an inexpensive three millimeter diameter hysteroscope with a through lumen was designed and developed for comfortable office use, with or without either a surrounding sheath or a video camera. A multicenter pilot study was performed in 34 patients, comparing image quality, ease of viewing, requirements for anesthesia, and patient discomfort associated with the use of the new and other hysteroscopes. Because the device could almost always be inserted without dilation of the cervix and pain, discomfort and requirements for anesthesia were reduced compared with standard hysteroscopes. The angled eyepiece permitted comfortable viewing without the need for a video camera. Image size was smaller and the quality was slightly reduced compared with larger diameter hysteroscopes, but in most instances, with fluid media, visualization was adequate for diagnostic evaluation.
Journal Article↗
Fertility after hysteroscopic myomectomy.
The available data concerning hysteroscopic myomectomy for submucous myomas has been reviewed with the aim of evaluating the safety and efficacy of this technique in infertile women who wish to preserve or to enhance their fertility potential. A total of 134 infertile patients undergoing hysteroscopic myomectomy by resectoscope or by Nd: YAG laser or by scissors have been collectively recorded. Of these, 79 (58.9%) patients conceived. This clinical outcome is similar to that occurring after laparotomic submucous myomectomy. Moreover, the hysteroscopic approach has several advantages over its abdominal counterpart, such as reduction of length of time of hospitalization, less morbidity and no hysterotomy. The operative risk of hysteroscopic myomectomy is < 3%. Uterine perforation, distension system hazard, infection and haemorrhage are the commonest complications. Hysteroscopic myomectomy is a safe, effective and relatively simple surgical procedure for the restoration of fertility.
Female↗
[The development of a new operating hysteroscopic fiberscope and its clinical application].
A new operating hysteroscopic fiberscope consisting of soft and rigid parts (4.8mm outer diameter) was developed with the support of Fuji Photo Optical Company. The working part of the scope can be divided into three sections: A flexible soft front section, a rotary rigid middle section and a flexible self retained semirigid rear section. With these functional parts the intrauterine target can be approached directly to perform the following operations. 1. Directed intrauterine biopsy. Thirty-five patients diagnosed as having endometrial polyp (13), submucous myoma (8), endometrial hyperplasia (4), endocervical polyp (3), endometrial carcinoma (2) and others (5) underwent direct biopsy with hysteroscopic control. No cervical dilatation or anesthesia was necessary. 2. Transcervical recanalization. In six cases of proximal tubal occlusion, a ureteral catheter or a percutaneous coronary balloon angiocatheter was introduced into the tubal ostium of the obstructed side to resolve the occlusion successfully with concomitant laparoscopy. 3. Hysteroscopic chorionic villus sampling. Chorionic villus sampling was performed with a ureteral catheter under direct hysteroscopic control and ultrasound guidance in eighteen pregnant women at from seven to fourteen gestational weeks. In fifteen cases, the samplings were performed satisfactory. 4. Removal of a lost IUD. Three cases of lost IUD underwent hysteroscopic removal without difficulty. Our results have proved that this scope is a very useful tool for intrauterine operations.
Adult↗
[Contact hysteroscopic exploration of the uterine cavity].
The contact hysteroscope gives a clear view only upon contact with the observed surface. There are 6mm and 8mm diameter models. A total of 172 contact hysteroscopic examinations were performed to view the uterine cavity. The following results were obtained: After the previous observation with the panoramic hysteroscope, the rate of correct diagnosis with the 6mm model was 83.3% and that with the 8mm one was 98.5%. The rate of correct diagnosis with the 8mm model was 85.3% and that with the 6mm one was 92.7%, when used initially. The main disadvantages of the contact hysteroscope were a lack of perspective view and occasional existence of a dead angle just above the internal os. Among the contact hysteroscopic diagnosis, that of endometrial polyp was the most difficult, followed by those of slightly bulging submucous myoma and endometrial hyperplasia, while diagnosis of IUD, hydatidiform mole and endometrial carcinoma were easier. After acquiring the necessary experience, the 6mm model also gave very accurate results, requiring no cervical dilatation in multiparous cases. The 6mm model should therefore be a useful instrument to use in outpatient diagnosis.
Endoscopes↗
Hysteroscopic treatment of menorrhagia associated with uterine leiomyomas.
OBJECTIVE: To determine the effectiveness of hysteroscopic treatment of menorrhagia associated with uterine leiomyomas. METHODS: Fifty-one women with uterine myomas were treated for menorrhagia by hysteroscopic resection with or without endometrial ablation. Patients were followed for 1-5 years after treatment. RESULTS: The mean number of pads used during the heaviest day of menses decreased from 17.8 before treatment to 6.8 after treatment (P < .005) in women undergoing resection only, and from 21.4 to 1.7 pads per day in women whose treatment included endometrial ablation (P < .001). Two-thirds of the women who underwent ablation were completely amenorrheic after the procedure. Both groups experienced significant decreases in dysmenorrhea. Three patients subsequently underwent hysterectomy after hysteroscopic treatment, and one required a repeat hysteroscopic procedure. CONCLUSION: Hysteroscopic treatment of menorrhagia associated with uterine myomas can be effective in carefully selected patients.
Adult↗
Reproductive outcome following hysteroscopic adhesiolysis in Asherman's syndrome.
OBJECTIVE: To determine whether hysteroscopic adhesiolysis improves reproductive outcome in women with Asherman's syndrome and pregnancy failure. SUBJECTS: Ninety consecutive women who had undergone hysteroscopic adhesiolysis of intrauterine adhesions during a 5-year period. Only women in whom at least two previous pregnancies had ended with either a spontaneous abortion or a premature delivery accompanied by fetal or neonatal mortality and a hysteroscopic diagnosis of intrauterine adhesions were enrolled. RESULTS: Whereas pregnancy outcome prior to the operation was 18.3% term deliveries, 3.3% premature deliveries, 62.4% first-trimester abortions, and 16.0% late abortions, after hysteroscopic adhesiolysis pregnancy outcome was 68.6% term deliveries, 9.3% premature deliveries, 17.4% first-trimester abortions, and 4.7% late abortions. In women with two previous unsuccessful pregnancies, the operative success rate measured by delivering a healthy newborn improved from 18.3% preoperatively to 64% postoperatively. In women with three or more unsuccessful pregnancies the success rate improved from 18.3% to 75%. Successful outcome of adhesiolysis was observed in 61.9% of mild (stage I) and in 70.6% of moderate to severe cases (stages II and III) of intrauterine adhesions. CONCLUSION: Hysteroscopic adhesiolysis in women with Asherman's syndrome and poor reproductive performance contributes significantly to a successful reproductive outcome.
Female↗
Use of rigid hysteroscope for extraction of foreign bodies embedded in lower urinary tract.
PURPOSE: To introduce the use of the 20F rigid hysteroscope in urologic procedures. MATERIALS AND METHODS: The 20F hysteroscope was used to remove deeply embedded foreign bodies from the lower urinary tract of three patients in whom previous attempts with standard cystoscopic equipment were unsuccessful. RESULTS: In all three cases, the hysteroscope easily passed into the urethra and with the use of rigid instruments was able to remove the foreign bodies without complication. CONCLUSION: Situations may arise when the removal of embedded foreign bodies is not possible with standard cystoscopic equipment. The hysteroscope, which is available in most operating rooms, was able to extirpate even deeply embedded foreign bodies.
Aged↗