Hysteroscopy (Operative)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated May 14, 2026

Operative hysteroscopy is the therapeutic use of a hysteroscope to treat intrauterine pathology identified during visualization, using specialized instruments passed through the operative channel of the scope. It extends the diagnostic procedure directly into treatment: the same cavity view used for diagnosis becomes the operative field, without abdominal incision or the need for a separate surgical admission in most cases.¹²

Established indications include resection of endometrial polyps, submucosal fibroids (leiomyomas), division of a uterine septum, lysis of intrauterine adhesions in Asherman syndrome, and repair of an isthmocele. Removal of a malpositioned IUD and tubal cannulation are also performed hysteroscopically. For many of these indications, ambulatory (office-based) operative hysteroscopy produces comparable outcomes to operating room procedures, while avoiding general anesthesia and reducing cost.¹²

In a root-cause fertility evaluation, operative hysteroscopy addresses structural conditions inside the uterine cavity that suppress implantation or contribute to pregnancy loss. A septum that divides the implantation surface, adhesions that restrict the cavity, or a polyp occupying the site where an embryo would implant are correctable causes. Treating them restores the uterine environment without bypassing it. For hysteroscopic isthmocele repair specifically, the procedure addresses the structural defect that the cesarean scar created in the lower uterine segment.

Operative hysteroscopy is preceded by diagnostic hysteroscopy or SIS to characterize the pathology before intervention. When both are performed in sequence, the transition from diagnosis to treatment occurs within the same procedure.²

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.