Cervical Stenosis: In – office Hysteroscopy Treatment using Hysteroscopic Tissue Removal System

Objective: To demonstrate how cervical stenosis can be safely and successfully treated in-office hysteroscopy using a hysteroscopic tissue removal system (HTRS – Truclear 5C or Elite).

Design: A demonstration of the surgical technique using slides, pictures, and video.

Setting: Cervical stenosis (CS) is one of the limitations and causes of failure of in-office Hysteroscopy1. Traditionally CS treatment is documented in the literature with the use of 5 Fr mechanical instruments, such as biopsy forceps, scissors, bipolar electrode needle or twizzle or versa point. 2

Interventions: This video shows an In-Office Hysteroscopy with HTRS for treating CS, in a stepwise approach to reduce patient discomfort and increase the success rate of in-office Hysteroscopy.

1. Vaginoscopy technique
2. Identification of the type of CS
3. Introduction of the 2.9 mm incisor TM with a 5mm cutting window through the channel of theHysteroscopy
4. The window of the incisor TM is placed against the fibrotic part of the cervix
5. Keep the window always under the vision
6. Keep the internal os in the centre of the vision
7. Circumferential cutting by the incisor without moving the scope
8. Controlled Suction
9. Advance by moving forward the bevel of the scope
10. Enter the uterine cavity

The use of miniature instruments, vaginoscopy and the technique of circumferential cutting of the fibrosis in the cervix allows the hysteroscope to pass easily into the uterine cavity with minimal patient discomfort.