BACKGROUND: Hysteroscopy represents the gold standard for the diagnosis and treatment of intrauterine pathologies. The advent of the mini-resectoscope heralded a new era in intrauterine surgery, both in inpatient and outpatient settings.
OBJECTIVE: To evaluate the effectiveness, safety, and feasibility of the mini-resectoscope for the treatment of intrauterine pathologies.
METHODS: Electronic databases were searched for English-language trials describing surgical procedures for uterine pathologies performed with a mini-resectoscope until 30 April 2023.
METHODS: Retrospective or prospective original studies reporting the treatment of uterine pathologies with mini-resectoscope were deemed eligible for the inclusion.
METHODS: Data about study features, characteristics of included populations, surgical procedures, complications, and results/outcomes were collected.
RESULTS: Seven papers that met the inclusion criteria were included in this systematic review. Quantitative analysis was not possible due to data heterogeneity. A descriptive synthesis of the results was provided accordingly to the pathology hysteroscopically removed/corrected: polyps and myomas, uterine septum, intrauterine synechiae, and isthmocele.
CONCLUSIONS: The mini-resectoscope is poised to play a leading role in hysteroscopic surgery for many pathologies, both in inpatient and outpatient settings. Since some applications of the mini-resectoscope have not yet been thoroughly investigated, future studies should address current knowledge gaps, designing high-quality comparative trials on specific applications.

To identify technologies associated with the least operative pain in women undergoing operative office hysteroscopic procedures.
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched until January 2021 using a combination of keywords \"hysteroscop*,\" \"endometrial ablation,\" \"outpatient,\" \"ambulatory,\" \"office,\" and associated Medical Subject Headings.
Randomized controlled trials evaluating the effect of hysteroscopic devices on pain experienced by women undergoing operative office hysteroscopy were included. Data were also collected regarding efficacy, procedural time, adverse events, and patient/clinician acceptability and/or satisfaction.
The search returned 5347 records. Ten studies provided data for review. Two trials compared endometrial ablation using bipolar radiofrequency with thermal balloon energy, with no significant difference in pain observed (p <.05). Seven trials evaluated technologies for endometrial polypectomy, of which, 4 compared energy modalities: miniature bipolar electrode resection against resectoscopy (N = 1), morcellation (N = 2), and diode laser resection (N = 1). Two studies compared hysteroscope diameter, and one study compared methods of polyp retrieval. A significant reduction in pain was found using morcellators rather than miniature bipolar electrosurgical devices (p <.001), 22Fr rather than 26Fr resectoscopes (p <.001), and 3.5-mm fiber-optic hysteroscopes with 7Fr forceps rather than 5-mm lens-based hysteroscopes with 5Fr forceps (p <.05). One study investigating septoplasty showed significant reduction in pain when cold mini-scissors, rather than a miniature bipolar electrode, were used (p = .013). Average procedural times ranged from 5 minutes 28 seconds to 22 minutes. The incidence of adverse events was low, and data regarding efficacy and acceptability/satisfaction were limited.
Pain is reduced when mechanical technologies such as morcellators and scissors are used compared with electrical devices for removing structural lesions in the office. For hysteroscopic and ablative procedures, smaller and quicker devices are less painful. Large-scale RCTs investigating patient pain and experience with modern operative devices in the office setting are urgently needed.

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BACKGROUND: Mini-hysteroscopy is believed to be pain-free or in the least bearable. Office procedures are therefore usually performed without analgesia or anesthesia. Is it indeed as tolerable as papers and authors suggest?
OBJECTIVE: To estimate what proportion of women reports moderate to severe discomfort during examination using the smaller diameter scopes.
METHODS: Online sources were search with key words \"hysteroscopy\" and \"pain\" from 2000 to December 2014. Thirty-five articles were retrieved for detailed analysis.
METHODS: Randomized controlled trials (RCT) and well-designed prospective trials (PT) studying pain as main outcome, in office mini-hysteroscopy in at least one arm. Studies or arms within a study where conscientious sedation, anesthesia, or non-steroidal drugs were used were excluded. Chosen data collected was the number of women referring moderate to severe pain compared to total women with intervention in the arm or study. Authors were contacted to try to retrieve unpublished data for analysis.
METHODS: We performed a meta-analysis from eight studies (six RCT and two PT) comparing pain reported as moderate or severe to total women in mini-hysteroscopy.
RESULTS: A meta-analysis estimated the pooled prevalence of pain (>3-10 on 10 cm visual analog scale) for all studies and by two subgroups: (1) RCT and (2) PT. Due to significant heterogeneity between studies, we used the random effects model. Results revealed a high prevalence of pain in outpatient mini-hysteroscopy.
CONCLUSIONS: Office mini-hysteroscopy is painful.

BACKGROUND: Hysteroscopy is an indispensable approach in gynecology. Miniaturization may reduce pain allowing office procedures without anesthesia.
OBJECTIVE: Our main objective is to determine if modifications in scope diameters have made office hysteroscopy less painful.
METHODS: Studies were sought with key words \"hysteroscopy\" and \"pain\" from available online sources. Time frame was from 2000 onward. Thirty-three articles were retrieved for detailed analysis.
METHODS: Prospective randomized trials, studying pain as main outcome in office hysteroscopy expressed in means, confidence intervals and SD, comparing office mini-hysteroscopy to conventional hysteroscopy. Studies or arms within a study where conscientious sedation, anesthesia or non-steroidal drugs were used were excluded.
METHODS: We analyzed data from eight studies (seven RCT) comparing mini-hysteroscopy with conventional scopes, involving a total of twenty-three hundred and twenty-two participants, of which nineteen hundred and eighty-six completed the intervention.
RESULTS: A meta-analysis revealed a significant reduction pain score (MD: -3.64; 95 % CI -5.16 to -2.12; test for overall effect p < 0.00001) and available data support miniaturization decreases pain in outpatient hysteroscopy.
CONCLUSIONS: Pain in office hysteroscopy is lower with mini-hysteroscopes.

The aim of this study was to analyze all available evidence regarding the use of intrauterine morcellator (IUM), for treatment of the most prevalent intrauterine benign lesions, compared to both traditional resectoscopy and conventional outpatient operative hysteroscopy in terms of safety, efficacy, contraindications, perioperative complications, operating time, and estimated learning curve. We reported data regarding a total of 1185 patients. Concerning polypectomy and myomectomy procedures, IUM systems demonstrated a better outcome in terms of operative time and fluid deficit compared to standard surgical procedures. Complication rates in the inpatient setting were as follows: 0.02% for IUM using Truclear 8.0 (Smith & Nephew Endoscopy, Andover, Massachusetts) and 0.4% for resectoscopic hysteroscopy. No complications were described using Versapoint devices. Office polipectomy reported a total complication rate of 10.1% using Versapoint device (Ethicon Women\'s Health and Urology, Somerville, New Jersey) and 1.6% using Truclear 5.0 (Smith & Nephew Endoscopy). The reported recurrence rate after polypectomy was 9.8% using Versapoint device and 2.6% using Truclear 8.0. Finally, the reported intraoperative and postoperative complication rate of IUM related to removal of placental remnants using Truclear 8.0 and MyoSure (Hologic, Marlborough, Massachusetts) was 12.3%. The available evidence allows us to consider IUM devices as a safe, effective, and cost-effective tool for the removal of intrauterine lesions such as polyps, myomas (type 0 and type 1), and placental remnants. Evidence regarding Truclear 5.0 suggests that it may represent the best choice for office hysteroscopy. Further studies are needed to confirm the available evidence and to validate the long-term safety of IUM in procedures for which current data are not exhaustive (placental remnants removal).

OBJECTIVE: The purpose of this article is to review the published literature and perform a systematic review to evaluate the effectiveness and feasibility of the use of a hysteroscope for vaginoscopy or hysteroscopy in diagnosing and establishing therapeutic management of adolescent patients with gynecologic problems.
METHODS: A systematic review.
METHODS: PubMed, Web of science, and Scopus searches were performed for the period up to September 2013 to identify all the eligible studies. Additional relevant articles were identified using citations within these publications.
METHODS: Female adolescents aged 10 to 18 years.
RESULTS: A total of 19 studies were included in the systematic review. We identified 19 case reports that described the application of a hysteroscope as treatment modality for some gynecologic conditions or diseases in adolescents. No original study was found matching the age of this specific population.
CONCLUSIONS: A hysteroscope is a useful substitute for vaginoscopy or hysteroscopy for the exploration of the immature genital tract and may help in the diagnosis and treatment of gynecologic disorders in adolescent patients with an intact hymen, limited vaginal access, or a narrow vagina.

Office hysteroscopy is an excellent method of identifying and treating intracavitary uterine lesions. It has become easy to learn and perform; as an aid of modern technological applications, it is safe, accurate, provides immediate results under direct visualisation, and offers the additional benefit of histological confirmation and the discomfort of patients is minimal. We applied an extended literature search to explore the special features and details of the technique itself, as it evolved since it first appeared 30 years back. Our initial goal was to examine potential changes/improvements of the modality, in terms of the instrumentation used and the technique itself, the indications of use, its incorporation in daily practice, and patients\' and clinicians\' acceptability.

Hysteroscopic myomectomy currently represents the standard minimally invasive surgical procedure for treating submucous fibroids, with abnormal uterine bleeding and reproductive issues being the most common indications. While hysteroscopic myomectomy has been shown to be safe and effective in the control of menstrual disorders, its effects on infertility remain unclear. The review provides a comprehensive survey of all hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2). MEDLINE and EMBASE searches identified published papers from 1970. The choice of the technique mostly depends on the intramural extension of the fibroid, as well as on personal experience and available equipment. \'Resectoscopic slicing\' still represents the \'gold standard\' technique for treating fibroids G0, even if several other effective techniques including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy have been proposed. On the other hand, the present review clearly indicates that there is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. Most techniques aim at the transformation of an intramural fibroid into a totally intracavitary lesion, thus avoiding a deep cut into the myometrium. At present, the \'cold loop\' technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium.

Rapid progress has been made in the last 10 years regarding minimally invasive access to the human fallopian tube. Coaxial catheter systems are being used with hysteroscopy, fluoroscopy, ultrasonography, and tactile sensation to cannulate the fallopian tube transcervically with consistent success. Uterotubal obstruction viewed at the time of hysterosalpingogram can often be successfully cannulated with intrauterine pregnancies resulting. This review surveys all available published series of transcervical tubal cannulation with discussion of methodology, success in establishing patency, and the resultant pregnancy rates. It also describes how this technology has been applied to the intratubal deposition of gametes and embryos, direct visualization of the tubal epithelium, (falloposcopy), and contraception. Collectively, these techniques are defining tubal pathology more precisely, allowing us to prescribe the proper therapy.