Modern gynaecology has witnessed a rapid evolution and a widespread application of endoscopic techniques over the past 20 years, particularly those seen in hysteroscopy. This has been made possible mainly due to technological developments relating to instrumentation and equipment, along with continuous improvements related to surgical techniques. The advances in technology and techniques, have made hysteroscopy less painful, less invasive and an outpatient procedure . Together with transvaginal ultrasound it provides the gold standard for diagnosis of uterine pathology.

Hysteroscopy enlarges the diagnostic capacity by minor surgical operative procedures like removal of IUD, biopsy or removal of polyps and minor synechiolysis.

This chapter provides a description of basic hysteroscopic procedures including simple operative procedures like second- and third-generation endometrial ablation and grade 0 to grade 1 myomectomy for small myomas.

The improvements in techniques, endoscopic instrumentation and surgical experience have completely changed the approach to uterine intracavitary pathologies, allowing the physician to achieve more reliable diagnostic and therapeutic results. The advent of these new technologies allows us today to improve advanced hysteroscopic surgery by increasing the efficacy of an operating room environment but avoiding the need for the inpatient setting for most of the procedures. It is possible to treat severe cervical stenosis or intrauterine synechiae, including Asherman’s syndrome, G2 myomas, congenital uterine malformations, adenomyosis and chronically retained products of conception in an ambulatory setting. The future looks to further the simplification of instrumentation, and establish a safer and easier delivery of energy sources.

This chapter provides a description of advanced hysteroscopic procedures and their benefits in modern gynaecological practice.