New developments in ambulatory hysteroscopic surgery

In the last decade, advancements have been made in hysteroscopic techniques, instrumentation and indications. Vaginoscopic hysteroscopy is performed without medication, cervical dilation and use of vaginal speculum or cervical tenaculum. To prevent complications during uterine access, both misoprostol and laminaria are equally effective for cervical priming. The use of normal saline to distend the uterus prevents hyponatraemia, but hypervolaemia may still be a major problem. Irrigant fluid deficit is best monitored by automated devices. Bipolar electrosurgical systems do not require dispersive return electrodes and do not generate stray currents, thus minimizing the risk of electrical burns. Tissue debulking and extraction are facilitated by vaporizing electrodes or morcellators. Hysteroscopic indications have expanded to include diagnosis and treatment of missed abortion, and cervical and interstitial pregnancies. The most important advancement of hysteroscopy has been proximal tubal access for sterilization.