Starting an Office Hysteroscopy Service: A Practical Guide for Gynaecologists

Office hysteroscopy, performed in an outpatient setting without general anaesthesia, has changed how gynaecologists evaluate the uterine cavity. With small-diameter scopes, many diagnostic procedures and minor treatments can be done in a single visit. For a fertility or gynaecology practice, it is a valuable service to offer.

Why offer office hysteroscopy?

• Faster diagnosis: patients do not wait for a theatre slot
• See and treat: many polyps and small lesions can be removed in the same sitting
• Comfort and convenience: no general anaesthesia for suitable patients
• Better fertility work-up: direct assessment of the uterine cavity when indicated

Equipment you will need

• A small-diameter hysteroscope suitable for office use
• A light source, camera and monitor
• A fluid distension system, usually with normal saline
• Mechanical instruments (scissors and graspers) for minor procedures
• Facilities for cleaning and sterilising instruments
• Documentation, including image or video capture

Keeping patients comfortable

Patient comfort makes or breaks an office service:

• Vaginoscopic ("no-touch") approach: entering without a speculum or tenaculum reduces discomfort
• Good counselling: explain what the patient will feel and that they can ask to pause
• Gentle technique: slow, controlled movement and appropriate distension pressure
• Appropriate case selection: some patients and procedures are better suited to theatre

Which cases suit the office?

Office hysteroscopy suits diagnostic evaluation and minor procedures such as small polypectomy or targeted biopsy. Larger fibroids, extensive adhesions and complex septa are usually better treated in theatre with appropriate anaesthesia and equipment.

Safety first

Even in the office, safety principles apply:

• Monitor fluid use
• Maintain orientation and stop if the view is lost
• Recognise complications such as perforation early
• Have a clear plan for referral to theatre when needed

Building your skills

Skills should be built progressively: equipment training, simulation or dry-lab practice, supervised diagnostic procedures, then supervised minor operative procedures. A logbook of procedures and outcomes helps track progress. Our article on hysteroscopy training for gynaecologists explains each stage in more detail.

Hysteroscopy in fertility care

For couples with infertility, hysteroscopy is most valuable when there is a clinical or imaging indication, or after recurrent implantation failure. Read more about the role of hysteroscopy in infertility.

Train with ReproNest

ReproNest's Diagnostic & Operative Hysteroscopy Training in Delhi NCR takes gynaecologists from equipment basics to supervised procedures. Contact us for the next batch.