Hysteroscopy.

This review discusses advances in hysteroscopy in the past decade, including the introduction of small-caliber endoscopes, microhysteroscopy, the flexible steerable hysteroscope, and the use of video systems in monitoring hysteroscopic evaluations. Media for uterine distension are reviewed and possible complications of the use of dextran 70 are discussed. Hysteroscopy is superior to curettage for evaluating abnormal uterine bleeding. Hysteroscopy can be used as an adjunct to hysterosalpingography, endometrial biopsy, and laparoscopy in evaluating infertility, and in detecting and treating intrauterine adhesions. The method has also been applied to the division of uterine septa, the removal of submucous leiomyomas, and tubal cannulation both for treating tubal obstruction at the cornual areas and in conjunction with new reproductive technologies. The use of the microcolpohysteroscope to tailor the size and extension of a cervical conization is described. Finally, hysteroscopy permits evaluation of the extension and involvement of the endocervical canal in patients with endometrial neoplasia and offers an important guide in staging and planning treatment for this condition.