Hysteroscopic management of a stenotic cervix

Objective To demonstrate an approach to the hysteroscopic management of a stenotic cervix. Design Step-by-step explanation of the techniques using video and animation (educational video). Setting Academic tertiary level referral center. Patient(s) Patients with cervical stenosis, inclusive of both reproductive age and postmenopausal women. Gynecologists require intrauterine access for many procedures, but a stenotic cervix can obstruct surgery. Blind dilation of a stenotic cervix can lead to a cervical laceration or uterine perforation, with concomitant complications. Intervention(s) The hysteroscopic management of a stenotic cervix includes optimizing the surgical environment, performing vaginoscopy and “no-touch” hysteroscopy, and revision of the cervical canal. Revision can be performed using microscissors, micrograspers, or a cutting loop electrode. Partial cervical canal excision to aid in hysteroscopy access should be reserved in women who are not interested in future pregnancy or those who are postmenopausal. Outpatient hysteroscopy uses smaller instruments and shows operative success with patient satisfaction. Although these techniques are demonstrated in an outpatient hysteroscopy setting, they can be adapted for use in an operating theater. Main Outcome Measure(s) The individual steps and approach are emphasized. Result(s) Intrauterine access can be achieved with various techniques. Conclusion(s) The “see-and-treat” approach demonstrated in this video can allow access into the uterine cavity despite a stenotic cervix. © 2017 American Society for Reproductive Medicine