O&G · Perioperative — diagnostic and operative gynaecology
Hysteroscopy
Also known as Hysteroscopy · Outpatient hysteroscopy · Office hysteroscopy · Operative hysteroscopy · Hysteroscopic polypectomy · Hysteroscopic myomectomy · Septum resection · Endometrial ablation · TURP syndrome hysteroscopy · Fluid overload hysteroscopy
Exam-exhaustive FRANZCOG fellowship reference on hysteroscopy — indications (diagnostic and operative, polypectomy, myomectomy, septum resection, ablation), distension media (saline vs glycine), fluid deficit thresholds (1000 / 1500 / 2500 mL), perforation with laparoscopy, fluid overload / intravascular absorption syndrome, haemorrhage, infection, and the outpatient / see-and-treat evidence base (RCOG GTG 59 2024, ACOG 800, AAGL). RANZCOG-primary, globally tagged.
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Red flags
- Restlessness, nausea, visual disturbance with falling end-tidal CO2 during operative hysteroscopy — intravascular absorption syndrome until proven otherwise
- Sudden loss of distension pressure with bowel or omentum in view — uterine perforation
- Fluid deficit approaching 1000 mL saline or 1500 mL glycine — stop the procedure
- Bleeding >500 mL during resection that does not settle — uterotonics, intrauterine balloon, call for help
- Sodium under 120 mmol/L with neurological signs after glycine — hypertonic saline 3% with slow correction
- Postmenopausal woman with an endometrial polyp — send all tissue for histology
It is 10:00 in the outpatient hysteroscopy suite. The nurse hands you a 38-year-old with two years of intermenstrual bleeding, a normal examination, a normal ultrasound, and a pre-medication of ibuprofen 400 mg taken an hour ago. The chair reclines, the vaginoscope enters under saline flow without a speculum, the cavity distends, the ostia appear, and there at six o'clock is a 1 cm smooth pedunculated polyp. You have a choice: refer her to day surgery for operative hysteroscopy in six weeks, or pick up the 5 Fr graspers and remove it now. Outpatient 'see and treat' is the modern default — and the guidelines that anchor that decision are the ones on this page.[2]
Overview and definition
Hysteroscopy is endoscopic visualisation of the cervical canal and uterine cavity, performed for diagnosis and increasingly for operative intervention in the same setting.[3]
- Definition: endoscopic examination of the cervical canal and uterine cavity via a rigid, semi-rigid or flexible scope, with appropriate distension medium and instrumentation as required.
- Setting: outpatient ('office', 'see and treat') versus inpatient (under general or regional anaesthesia).
- Diagnostic vs operative: diagnostic confirms structural abnormality (palpation not enough; direct visualisation is the gold standard); operative intervenes in the same or subsequent setting.
- The FIGO PALM-COEIN framework classifies structural causes of AUB as Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia — the PALM group — all of which hysteroscopy can diagnose, biopsy or treat.
References6ShowHide
- [1]American College of Obstetricians and Gynecologists Committee on Gynecologic Practice The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol, 2020.PMID 32080054
- [2]Shokeir T, El-Lakkany N, Sadek E, El-Shamy M, Abu Hashim H An RCT: use of oxytocin drip during hysteroscopic endometrial resection and its effect on operative blood loss and glycine deficit. J Minim Invasive Gynecol, 2011.PMID 21571595
- [3]Giacobbe V, Rossetti D, Vitale SG, Rapisarda AM, Padula F, Laganà AS, Palmara VI Otorrhagia and Nosebleed as first signs of Intravascular Absorption Syndrome During Hysteroscopy: From Bench to Bedside. Kathmandu Univ Med J (KUMJ), 2016.PMID 27892449
- [4]Ahmad G, Baker J, Finnerty J, Phillips K, Watson A Laparoscopic entry techniques. Cochrane Database Syst Rev, 2019.PMID 30657163
- [5]Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med, 2015.PMID 26095867
- [6]Moore JF, Carugno J Hysteroscopy StatPearls, 2026.PMID 33232015