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.
Identification of the type of CS
Introduction of the 2.9 mm incisor TM with a 5mm cutting window through the channel of theHysteroscopy
The window of the incisor TM is placed against the fibrotic part of the cervix
Keep the window always under the vision
Keep the internal os in the centre of the vision
Circumferential cutting by the incisor without moving the scope
Advance by moving forward the bevel of the scope
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.
1: Capmas P, Pourcelot AG, Giral E, Fedida D, Fernandez H. Office hysteroscopy: A report of 2402 cases. JGynecol Obstet Biol Reprod (Paris) 2016;45:445‐50.
2: Bettocchi S, Bramante S, Bifulco G, Spinelli M, Ceci O, Fascilla FD, et al. Challenging the cervix:Strategies to overcome the anatomic impediments to hysteroscopy: Analysis of 31,052 officehysteroscopies. Fertil Steril 2016;105:e16‑7.