Office hysteroscopy is an exciting and rapidly advancing field of gynecologic practice that enables the direct visualization of the uterine cavity and the management of relevant uterine pathologic disorders.

In the early ages, hysteroscopy was performed in an office setting only for diagnostic purposes, due to the wide diameter of the instruments for operative hysteroscopy.

During the last two decades, the advancements in technologies, such as the development of small-diameter hysteroscopes, enabled gynaecologists to perform mainly operative hysteroscopic procedures in an office setting without the need of general anesthesia (office operative hysteroscopy).

The development of TRUCLEAR 5.0 system (Smith & Nephew), a hysteroscopic tissue removal device with a 5 mm scope, has represented a further incredible innovation in this field. Thanks to this new small mechanical device - simultaneously cutting and aspirating the pathology from the patient - polyps, small myomas and placenta remnants can be removed, in a rapid, effective and safe way without using electrosurgery even in an ambulatory setting.

The use of miniaturized instruments, electronic systems for the control of intrauterine pressure, and the modern bipolar technology represent fundamental advances to operate in safety in an ambulatory setting. The mechanical TRUCLEAR system further increases the safety of the operative procedures as i) it eliminates the risk of thermal injury and ii) requires fewer uterine reinsertions as compared to electrical resection, which could reduce the risk of damaging the uterus (i.e., perforation, creation of a false passage way) and incidences of air emboli caused by instrument reinsertion.
 
In conclusion, as novel instruments continue to arise, the perspectives for acquiring the best minimally invasive approach seem unlimited. Most of the intrauterine pathologies can be safely and successfully treated with office operative hysteroscopy.
 

ABOUT THE AUTHORS

About Prof. Attilio Di Spiezio Sardo, MD, PhD

Attilio Di Spiezio Sardo: Department of Neuroscience, Reproductive and Odontostomatological Sciences Division of Obstetrics and Gynecology, School of Medicine, "Federico II" University of Naples, Via Pansini 5,  80131  Naples, Italy