New developments in hysteroscopy

Diagnostic and operative hysteroscopy have become standards in gynaecologic practice. Many hysteroscopic procedures have replaced old, invasive techniques, such as dilatation and curettage. As instruments have reduced in size, office hysteroscopy has begun to replace operating-room procedures. New instruments and techniques continue to emerge, and the prospects for improvement seem unlimited. Discussed are hysteroscopic sterilisation, bipolar electrosurgery, hysteroscopic morcellation, and virtual hysteroscopy. Furthermore, the evidence for supporting the vaginoscopic approach, cervical preparation, pain medication and the use of local anaesthetics is presented. Main hysteroscopic procedures, such as polypectomy, myomectomy, adhesiolysis, metroplasty, and the role of hysteroscopy before embryo transfer, are reviewed, and what has been proven is further discussed.