Hysteroscopy is a pivotal tool in modern gynecology, offering direct visualization of the uterine cavity for diagnostic and therapeutic purposes. It allows for the identification and management of various intrauterine pathologies such as fibroids, polyps, adhesions, septa, and congenital anomalies, with minimal invasiveness.

Dr. R. K. Mishra, a pioneer in minimally invasive gynecology, has delivered numerous lectures and workshops emphasizing the principles, techniques, and applications of hysteroscopy. His approach integrates clinical insight, surgical precision, and patient safety, making hysteroscopy an essential skill for gynecologic surgeons worldwide.

Importance of Hysteroscopy

Hysteroscopy provides several advantages over traditional diagnostic methods:

Direct visualization: Unlike ultrasound or hysterosalpingography, hysteroscopy allows surgeons to see lesions directly.

Minimally invasive: Small-diameter hysteroscopes reduce patient discomfort and recovery time.

Simultaneous diagnosis and treatment: Polyps, submucosal fibroids, adhesions, and septa can often be managed in the same session.

Enhanced fertility evaluation: Helps in assessing endometrial abnormalities contributing to infertility or recurrent pregnancy loss.

Dr. Mishra emphasizes that hysteroscopy should be an integral part of gynecologic training, as it combines diagnostic accuracy with therapeutic capability.

Types of Hysteroscopy
Diagnostic Hysteroscopy

Performed to evaluate abnormal uterine bleeding, infertility, or suspected intrauterine pathology.

Typically uses a small-diameter hysteroscope (2–5 mm).

Saline or carbon dioxide is used to distend the uterine cavity for visualization.

Allows direct assessment of the endometrium, tubal ostia, and cavity morphology.

Operative Hysteroscopy

Used for therapeutic interventions such as:

Polypectomy

Myomectomy (submucosal fibroids)

Adhesiolysis in Asherman syndrome

Septum resection

Endometrial ablation

Operative hysteroscopes allow instrument passage through working channels for precise surgery.

Dr. Mishra emphasizes meticulous technique to avoid perforation and minimize fluid overload, key factors in operative safety.

Instruments and Equipment

Dr. Mishra highlights the importance of choosing appropriate instruments:

Hysteroscope: Rigid or flexible, depending on indication

Distension media: Saline, Ringer lactate, or CO₂

Electrosurgical instruments: Bipolar or monopolar devices for cutting and coagulation

Mechanical instruments: Scissors, graspers, and morcellators for tissue removal

Proper equipment selection ensures precision, safety, and efficiency in hysteroscopic procedures.

Technique Principles

Patient Preparation:

Usually performed under sedation or general anesthesia

Cervical priming may be used for nulliparous or postmenopausal women to facilitate cervical entry

Cervical Entry:

Gentle dilation and insertion of the hysteroscope under direct vision

Dr. Mishra emphasizes maintaining uterine axis alignment to reduce risk of perforation

Cavity Distension:

Adequate distension with fluid or gas provides optimal visualization

Intrauterine pressure is monitored to avoid fluid overload or hyponatremia

Systematic Inspection:

Thorough evaluation of endometrium, tubal ostia, and cavity shape

Identification of lesions and planning for operative intervention

Operative Procedures:

Use of precise cutting, grasping, and coagulation techniques

Continuous monitoring of fluid balance and uterine wall integrity

Applications in Gynecology

Dr. Mishra’s lectures emphasize practical applications of hysteroscopy:

Abnormal Uterine Bleeding: Diagnosis and removal of polyps, fibroids, or hyperplasia

Infertility: Identification of adhesions, polyps, or septa affecting implantation

Asherman Syndrome: Lysis of adhesions to restore normal cavity anatomy

Congenital Anomalies: Septum resection and correction of malformations

Endometrial Ablation: Management of menorrhagia resistant to medical therapy

Safety and Complications

Hysteroscopy is generally safe, but complications can occur if proper precautions are not taken:

Uterine perforation

Fluid overload or electrolyte imbalance

Infection

Bleeding

Dr. Mishra stresses training, meticulous technique, and patient selection to minimize complications and ensure optimal outcomes.

Conclusion

Hysteroscopy, as emphasized in Dr. R. K. Mishra’s lectures, is an essential diagnostic and therapeutic tool in gynecology. Its ability to combine precision, minimal invasiveness, and immediate treatment makes it invaluable for managing intrauterine pathologies.

By integrating proper technique, instrument selection, and patient safety, surgeons can achieve excellent outcomes, improved fertility, and enhanced patient satisfaction. Hysteroscopy continues to be a cornerstone of modern gynecologic practice, empowering surgeons to provide effective and minimally invasive care.