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.

A 70-year-old nulligravid woman presents with a three-month history of intermittent, painless vaginal spotting. The patient denies any vaginal bleeding or spotting since her last menstrual period 20 years ago. She initially noticed brown staining on her underwear. Currently, she wears a pad which she changes daily. She reports regular bowel movements with no blood in her stools. She had her second colonoscopy four years ago. No abnormalities were noted. She denies any urinary complaints and has not noticed any hematuria. The patient was last sexually active 15 years ago. She denies any prior history of sexually transmitted infections. Her last Pap smear with co-testing was normal at age 65. She has no history of abnormal Pap smears. She has never taken hormone therapy. Her past medical history is significant for hypertension, hyperlipidemia, and diabetes mellitus. Her past surgical history is significant for laparoscopic cholecystectomy. She is currently taking lisinopril, atorvastatin, and glyburide and she has no known drug allergies.