Hysteroscopy is a cornerstone of modern gynecologic practice, providing direct visualization of the uterine cavity for diagnosis and treatment of intrauterine pathologies. Its minimally invasive nature allows surgeons to accurately evaluate the endometrium, identify abnormalities, and perform operative procedures with reduced recovery time and minimal complications.

Dr. R. K. Mishra, a pioneer in minimally invasive gynecologic surgery, delivered an insightful lecture at World Laparoscopy Hospital, focusing on the principles, techniques, and applications of hysteroscopy. His lecture highlighted both the diagnostic and therapeutic potential of hysteroscopy, emphasizing patient safety, precision, and fertility preservation.

Importance of Hysteroscopy

Hysteroscopy offers multiple advantages over traditional diagnostic techniques such as ultrasound or hysterosalpingography:

Direct visualization of the uterine cavity, enabling precise diagnosis

Minimally invasive intervention, reducing pain and hospital stay

Simultaneous diagnosis and treatment, including removal of polyps, fibroids, adhesions, and septa

Enhanced fertility assessment, identifying pathologies that may affect implantation or cause recurrent pregnancy loss

Dr. Mishra emphasized that hysteroscopy should be considered a first-line approach for managing intrauterine disorders due to its accuracy and versatility.

Types of Hysteroscopy Discussed
Diagnostic Hysteroscopy

Used to evaluate abnormal uterine bleeding, infertility, or suspected intrauterine pathology

Typically performed with small-diameter hysteroscopes (2–5 mm)

Utilizes fluid or gas to distend the uterine cavity for optimal visualization

Provides direct assessment of endometrial lining, tubal ostia, and cavity morphology

Operative Hysteroscopy

Enables therapeutic interventions:

Polypectomy

Submucous myomectomy

Adhesiolysis in Asherman syndrome

Septum resection

Endometrial ablation

Operative hysteroscopes allow instrument passage through working channels, enabling precise tissue manipulation

Dr. Mishra emphasized meticulous technique to minimize complications such as perforation or fluid overload

Hysteroscopic Instruments and Equipment

Dr. Mishra highlighted the critical role of instrumentation in safe and effective hysteroscopy:

Hysteroscopes: Rigid for standard procedures, flexible for complex anatomy

Distension media: Saline or Ringer lactate for bipolar instruments; glycine or sorbitol for monopolar use

Operative instruments: Resectoscopes, scissors, graspers, and morcellators

Ancillary tools: Cervical dilators, uterine manipulators, suction-irrigation systems

Proper selection, handling, and maintenance of instruments ensure precision, safety, and efficiency in both diagnostic and operative hysteroscopy.

Technique Principles

Dr. Mishra emphasized the following principles for safe and effective hysteroscopy:

Patient Preparation: Cervical priming, anesthesia, and uterine relaxation as needed

Gentle Cervical Entry: To reduce trauma and avoid perforation

Cavity Distension: Maintaining optimal intrauterine pressure for visualization and fluid safety

Systematic Inspection: Thorough evaluation of the endometrium, tubal ostia, and cavity for abnormalities

Operative Procedure: Precise tissue excision or coagulation while maintaining hemostasis and endometrial integrity

He emphasized that a stepwise, methodical approach improves safety, accuracy, and patient outcomes.

Applications of Hysteroscopy

Dr. Mishra discussed a wide range of clinical applications:

Abnormal Uterine Bleeding: Removal of polyps, fibroids, or hyperplastic endometrium

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

Asherman Syndrome: Lysis of intrauterine adhesions to restore cavity anatomy

Congenital Anomalies: Septum resection and correction of malformations

Endometrial Ablation: Minimally invasive management of menorrhagia

Hysteroscopy, when performed correctly, enhances fertility, resolves symptoms, and improves quality of life.

Safety and Complications

While hysteroscopy is safe, Dr. Mishra highlighted potential complications:

Uterine perforation

Fluid overload and electrolyte imbalance

Infection or bleeding

Rare thermal injury from electrosurgical instruments

He stressed that training, careful technique, and patient selection are essential to minimize risks and optimize outcomes.

Conclusion

The lecture by Dr. R. K. Mishra at World Laparoscopy Hospital provided comprehensive insights into hysteroscopy as a diagnostic and therapeutic tool. By combining advanced instrumentation, meticulous technique, and clinical expertise, surgeons can achieve high precision, safety, and excellent patient outcomes.

Hysteroscopy continues to be a cornerstone of modern gynecologic surgery, empowering surgeons to manage intrauterine pathologies effectively while preserving fertility, minimizing invasiveness, and enhancing recovery.