Hysteroscopy: an evolving case of minimally invasive therapy in gynaecology

Hysteroscopy is an endoscopic technique, allowing inspection of the intrauterine cavity. Diagnostic applications of the technique began to develop in the 1970s. Although it is often claimed that diagnosis under direct visualization is better than standard dilatation and curettage, it has not yet been proved that hysteroscopic diagnosis has better results than curettage. The clinical application of therapeutic hysteroscopy, mainly in the field of the treatment of abnormal uterine bleeding, started in the 1980s. Two thousand patients have been treated with either hysteroscopic myomectomy, endometrial resection, or endometrial laser ablation, according to the literature. No randomized trials have been conducted. The first clinical results of hysteroscopic treatment seem satisfactory, with average success rates of 85%. There is some evidence that the therapy is cost saving, because hysteroscopic procedures only require one or two nights in hospital. The technique is not yet widely diffused, mainly because of technical difficulties and lack of definite evidence on its effectiveness.