Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called “office hysteroscopy” or “see-and-treat hysteroscopy”, whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal.

Introduction: Hysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Given the safety and efficacy, diagnostic and operative hysteroscopy has become standard in gynecology practice. Aims: A retrospective analysis of 507 case records of patients who underwent hysteroscopy between July 2017 and December 2018 was conducted. The indications for hysteroscopy, type of anesthesia employed and the procedure performed were studied. Results: The most common indication for hysteroscopy was infertility. Most patients underwent hysteroscopy under general anesthesia. Thirty two percent of patients required total intravenous analgesia. Endometrial polypectomy and myomectomy were the commonly performed hysteroscopic procedures. Conclusion: Hysteroscopy is a safe, minimally invasive and well tolerated procedure which is increasingly used worldwide as a first-line investigation for infertility, abnormal uterine bleeding and other diseases involving the uterine cavity. Technological advancements in the instruments have enabled the use of hysteroscopy as an out-patient procedure.

1 he main capacity of hysteroscopy is the diagnosis of intrauterine diseases, however, there is a growing potential therapeutic approach. This is demonstrated since the first description of the method, when Pantaleoni in 1869 introduced a tube 12 mm in diameter into the uterine cavity of a woman of 60 years, with uterine bleeding and endometrial polyps detected. At the same act, he made cauterization with silver nitrate for hemostasis. Currently, hysteroscopy evolved with video system expanding the vision; smaller diameter instrumental and operative channel and through liquid distension. although, the biggest development was in relation to the technical procedure, because growing professional experience, with courses and training, promoting technical improvement and increasing the number of professionals with similar technical quality, brings the concept of see and treat. Today, hysteroscopy expanded the diagnostic possibility in cases of abnormal uterine bleeding, allowing the cleaning of the uterine cavity with fluid distension medium. The dynamic hysteroscopy, changing the intrauterine pressure, allows to lower pressures making possible the suspicion of intramural disorders such as fibroids "weighing" in cavity and adenomyosis, as well as the assessment of the uterine cavity distension capacity in cases of uterine malformations. The direct biopsy technique, which is taken under viewing the most significant lesion area and can be repeated several times in the same procedure as well as the possibility of endometrial biopsy, to drag the open forcep and withdrawing only seizing materials the cloth. The surgical technique was expanded, walking through using resectoscope with energy, mono or bipolar, or the use of grasping and scissors, allowing you to access the base of the lesion for its complete withdrawal. Large development also occurred in the treatment of diseases at the time of diagnosis, see and treat, as it can perform, polypectomy, Myomectomies, lysis of adhesions, septoplasty and removal of foreign bodies at the time of diagnosis. Thus, hysteroscopy reached a great brand, it has low cost because it is an outpatient procedure, with great diagnostic capacity and enormous potential for treatment in the same act, this all combined with easy extension of this knowledge with courses, training and adequate scientific information as the Hysteroscopy Newsletter.

Evaluation of the uterine cavity is an important part of the gynecological check, especially in symptomatic women and, over the last few decades, a number of technical and technological advancements has allowed a superb investigation of this organ. Traditionally, transvaginal ultrasound (TVUS) has been the first-line diagnostic tool for evaluating uterine diseases, also considering that gynecologists are familiar with the technique since it is included in the basic training in obstetrics and gynecology. Nevertheless, to date “office hysteroscopy” received growing attention since the development of smaller-diameter hysteroscopes which has made it possible to easily perform the hysteroscopy in ambulatory settings, obviating the need for anesthesia and dilatation of the cervical canal. According to our overview, none of the available methods for endometrial evaluation are ideal and each one has pros and cons. TVUS allows assessment of both the myometrium and the endometrium and typically offers greater patient comfort, but it has a higher false-negative rate in diagnosing focal intrauterine pathology. On the other hand, office hysteroscopy has the advantage of providing (most of the time) a real-time diagnosis avoiding anxiety, inconvenience and costs associated with follow-up appointments. The main advantage of the office hysteroscopy on the TVUS is the possibility to perform an operative phase if necessary during the examination itself. In fact, the modern smaller-diameter hysteroscopes have a working channel through which operative miniaturized instruments (mechanical instruments or bipolar electrodes) can be introduced, allowing the performance of target-eye biopsies and the “instant” treatment of most of uterine diseases in outpatient settings.

According to the definition of the World Health Organization (WHO), infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. One of the causes of sterility is inborn and acquired uterine anomalies. The best visualization of the inside of the uterus is achieved hysterscopically. Hysteroscopy is a minimally invasive surgical procedure and has the greatest significance in the diagnosis and treatment of congenital anomalies of the uterus. It is possible to eliminate and correct most of the congenital anomalies of the uterus, and it also enables the removal of other pathological changes in the cavity of the uterus. The incidence of congenital uterine anomalies in general population is 0.1-3.5%. Infertile patients have a higher incidence of these anomalies which range from 3-6%, and 5-10% in habitual abortions. The study included 200 infertile patients up to 40 years of age, with performed surgical hysteroscopy due to diagnosed changes ...