Hysteroscopes

Hysteroscopes are slender endoscopes designed for visualization of the internal surface of the uterine cavity. Inserted through the cervix, they provide direct assessment of the endometrium and can support targeted treatment. Most hysteroscopes integrate a viewing system, an illumination source, and a working channel through which surgical instruments or contrast media can be introduced. Modern units may be rigid or flexible, with rigid scopes offering straightforward navigation and flexible scopes allowing greater access in distorted anatomies. The devices are used with a distention medium, typically sterile saline or other low-viscosity fluids; carbon dioxide may be used in some settings, with careful monitoring of fluid balance.

Diagnostic hysteroscopy uses a small-diameter scope to assess structure and pathology, often performed in the outpatient setting. Operative hysteroscopy employs specialized instruments connected to the working channel to resect polyps or submucosal fibroids, perform adhesiolysis, perforation repair, or place devices.

Common indications include abnormal uterine bleeding, assessment of infertility or recurrent pregnancy loss, evaluation of submucosal fibroids, intrauterine adhesions, polyps, or uterine septa.

Relative contraindications include pregnancy, active pelvic infection, uncorrected cervical or uterine conditions, or severe uncontrolled coagulopathy; procedure risk increases with uterine distortion or prior surgery.

Compared with open or laparoscopic approaches, hysteroscopy is minimally invasive and often ambulatory, with rapid recovery. Potential complications include uterine perforation, fluid overload, infection, bleeding, and vasovagal reactions, most of which are mitigated by operator expertise and appropriate patient selection.