Hysteroscopy in 2025 or the hysteroscopy of the future
Seance of wednesday 29 january 2025 (Gynécologie Actualités et recherches)
DOI number : 10.26299/4y55-bm60/emem.2025.04.06
Abstract
The prerequisite is that Assisted Medical Procreation (AMP) techniques require a perfect uterine cavity at the risk of reducing implantation, which implies that operative hysteroscopy has become the major surgery to optimize the management of infertility.
At the same time, gynecologic surgeons are faced with a new paradigm that involves asking as the first question, whatever the reason for the consultation, "do you want to keep your possibilities of procreation" and this regardless of the age of the patients. Indeed, AMP techniques are possible, due to gamete donation, at any age and impose a new definition of the young woman because the surgeon can in all circumstances recreate or preserve a uterine cavity suitable for implantation.
The diagnosis of intracavitary pathologies is understood by performing 3D ultrasounds and preoperative sonography.
The goal in hysteroscopy is to aim for zero complications, comfort for the patient and the surgeon while respecting the recommendations of the RAC, particularly for performing myomectomies.
The new instrumentation will make it possible to offer surgeries outside the operating room, optimizing comfort and speed of care for patients while respecting the new care recommendations.
The new features are represented by the miniaturization of the instrumentation, the use of energy-free instrumentation (morcellators, operating hysteroscopes with 7fr instrumentation and no longer 5fr or 3mm instrumentation as allowed by Neocare) and 18Fr mini-resectoscopes with exclusive bipolar energy.
Recent creations offer XXL instruments allowing surgery in obese women and women with large cavities with hysterometry > 12 cm, and chip extractors for myomectomies opening up therapeutic possibilities for sizes > 5 cm in one operation.
At the same time, with the goal of zero complications, new anti-adhesion barriers limiting the risk of synechiae are made of polymer and remain in the uterine cavity for 8 days with promising efficacy results.
The hysteroscopy of the future defines a complex surgery, focused on the possibilities of procreation at any age and a surgery where all errors will be definitive and irreparable for the endometrium. This is why hysteroscopy must be definitively recognized as a surgical procedure and not just as an "examination" which is the case today.
At the same time, gynecologic surgeons are faced with a new paradigm that involves asking as the first question, whatever the reason for the consultation, "do you want to keep your possibilities of procreation" and this regardless of the age of the patients. Indeed, AMP techniques are possible, due to gamete donation, at any age and impose a new definition of the young woman because the surgeon can in all circumstances recreate or preserve a uterine cavity suitable for implantation.
The diagnosis of intracavitary pathologies is understood by performing 3D ultrasounds and preoperative sonography.
The goal in hysteroscopy is to aim for zero complications, comfort for the patient and the surgeon while respecting the recommendations of the RAC, particularly for performing myomectomies.
The new instrumentation will make it possible to offer surgeries outside the operating room, optimizing comfort and speed of care for patients while respecting the new care recommendations.
The new features are represented by the miniaturization of the instrumentation, the use of energy-free instrumentation (morcellators, operating hysteroscopes with 7fr instrumentation and no longer 5fr or 3mm instrumentation as allowed by Neocare) and 18Fr mini-resectoscopes with exclusive bipolar energy.
Recent creations offer XXL instruments allowing surgery in obese women and women with large cavities with hysterometry > 12 cm, and chip extractors for myomectomies opening up therapeutic possibilities for sizes > 5 cm in one operation.
At the same time, with the goal of zero complications, new anti-adhesion barriers limiting the risk of synechiae are made of polymer and remain in the uterine cavity for 8 days with promising efficacy results.
The hysteroscopy of the future defines a complex surgery, focused on the possibilities of procreation at any age and a surgery where all errors will be definitive and irreparable for the endometrium. This is why hysteroscopy must be definitively recognized as a surgical procedure and not just as an "examination" which is the case today.