Office hysteroscopic surgery utilize 5 French channels to introduce several tools either mechanic or electric needles and tweezers. The biggest advantage of office surgery is the possibility to avoid general anaesthesia and to perform almost all procedures in an outpatient setting. The great advantage of 5 Fr operative tools may become in several casesa limit, when intrauterine pathology is too large and needs to switch to classic resectoscope.
Recently mechanic energy has been adopted by operative hysteroscopes, either on office base (Truclear) in with bigger tools needing anaesthesia (Intrauterine Bigatti Shaver IBS).The advantages of shavers/morcelators is the possibility to avoid the use of electric energy.The blunt tip reduces the possibility to perforate the uterine wall.
Where are we going? Every uterine pathology needs an accurate pre-surgery diagnostic setup. To avoid possibile complications it is important to evaluate vascular invasion of trophoblastic retained tissue or to measure the healthy tissue between myoma and external serosa. It is very useful too keep an ultrasound machine in the operative theatre in order to assure maximal safety of the procedure.
The future I imagine is an integration between operative tools and ultrasound in order to have a surgery which will be precise and safe. Iimagine an automatic or computer guided surgery which integratesthe pre-surgery diagnostic setup and the cutting element in order toguide the operator like an airplane landing in the fog.