A 40-year-old nulligravid woman last menstrual period 15 weeks ago presents with irregular menstrual bleeding. Upon questioning, she has had irregular cycles for the last 20 years. She has never taken any hormonal medication to regulate her bleeding. She has never been pregnant despite not using contraception since age 21. You perform an endometrial biopsy and the pathologic diagnosis is endometrial intraepithelial neoplasia (EIN). She does not desire future fertility. Her past medical history is significant for hypertension and morbid obesity. She was recently diagnosed with diabetes and has adjusted her diet to try and control her blood sugar. She requests to have a hysterectomy for treatment of her irregular menses. She denies any significant family history of breast, ovarian, or colon cancer. She has no past surgical history. She is currently taking hydrochlorothiazide 25 mg PO daily and has no known drug allergies.

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.