Tips and tricks in office hysteroscopy

Office hysteroscopy is a minimally invasive procedure that has been shown to be highly accurate in diagnosing abnormalities of the endometrial cavity and the endocervical canal. It allows the direct visualizing of uterine pathology without the need for general anesthesia and the use of an operating room, generating cost savings and greater compliance among patients. The advent of small-diameter hysteroscopes, the use of saline solution as a distension media, as well as the vaginoscopic technique have widely contributed to the diffusion of this technique worldwide, and currently it can be considered the gold standard for the examination of the uterine cavity. The improved technology has also enabled surgeons to perform many operative procedures in an ambulatory setting without significant patient discomfort. With the development of miniaturized operative hysteroscopes and mechanical/electrified instruments, many surgical interventions on the uterine cavity can be actually performed safely and effectively in the office-based setting, introducing the concept of “see and treat hysteroscopy.” This review provides several tips and tricks to maximize the chance of success of an office hysteroscopy, either diagnostic or operative.