Resectoscopy

Resectoscopy is a hysteroscopic surgical technique that uses a resectoscope to visualize the uterine cavity and selectively remove or reshape intrauterine tissue. The resectoscope is a rigid endoscope with a working channel and a wire loop electrode that enables cutting and coagulation under direct vision. It is used for diagnostic assessment and for operative management of intrauterine pathology.

Indications include abnormal uterine bleeding associated with benign intrauterine lesions such as polyps, submucosal fibroids, and intrauterine adhesions, as well as evaluation and treatment of intrauterine pathology, removal of retained placental tissue, and hysteroscopic metroplasty in selected cases. It may be performed as a primary treatment to reduce or avoid hysterectomy in appropriate patients.

Procedure and technique involve placing the patient under anesthesia and dilating the cervix to access the uterine cavity. A distension medium is introduced to expand the cavity for visualization. The resectoscope is advanced into the uterus, and a loop electrode is used to resect targeted tissue, often with concurrent coagulation to control bleeding. Tissue fragments can be removed for histopathology. In some cases, the procedure is followed by additional maneuvers such as adhesiolysis or selective endometrial ablation. Postoperative recovery is typically brief, with guidance on activity and follow-up.

Equipment and energy use vary; modern practice often employs bipolar energy with isotonic saline as the distension medium, reducing electrolyte disturbance risks. Older monopolar systems used non-electrolyte fluids such as glycine, which carry higher risks of fluid imbalance. Outcomes are generally favorable for selected benign lesions, though risks include uterine perforation, infection, fluid overload, bleeding, and subsequent intrauterine adhesions.