Office hysteroscopy is now considered the gold-standard technique to evaluate uterine cavity and manage intracavitary pathologies in pre- and post-menopausal women, such as endometrial polyps, myomas, synechiae, hyperplasia, and endometrial cancer, offering elevated sensitivity and specificity, a high feasibility and a low complication rate. Hysteroscopy, as a diagnostic procedure, using small diameter scopes in ambulatory setting, offers the possibility of direct vision and biopsy of vagina and fornices, cervical canal, uterine cavity and tubal ostia. In addition, intracavitary surgical procedures may be performed both in office setting (see-and-treat approach) or operating room, depending on the complexity of the procedure. Furthermore, several studies have underlined the potential effectiveness of hysteroscopic management of intrauterine diseases, in order to improve reproductive outcomes and reducing time to pregnancy also in women undergoing assisted reproductive techniques. For this reason, hysteroscopy is also progressively consolidating as a routine procedure also in the infertility workup. Nevertheless, in some cases, hysteroscopy can be a painful procedure, especially when the uterine cavity is more difficult to reach. For these reasons, the development of different strategies to reduce anxiety and pain in the outpatient setting is still essential today.
In the light of these considerations, the Special Issue “Updates in hysteroscopic surgery: expanding the meaning of "in-office" aims to publish both original articles and comprehensive reviews about technical features and clinical applications of office hysteroscopy. Space will also be given to contributions aimed to investigate the most recent innovations in this field and the strategies for an adequate pain management during hysteroscopy.
Dr. Salvatore Giovanni Vitale and Dr.Osama Shawki and Dr. Yehia Shawki
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