Digital Hysteroscopy

Advances in surgical technology have made endoscopic instruments smaller, cameras sharper and more magnified, and image interpretation more reliable — including AI-assisted review of intracavitary findings. Together, these improvements let us perform endoscopy of the uterine cavity in the clinic rather than the hospital operating room. This approach is known as office hysteroscopy, and it is used both to diagnose (diagnostic hysteroscopy) and to treat (operative hysteroscopy).

3–4 mm

Scope diameter

≤ 10 cm

Depth into the body

~ 30 min

Typical procedure time

1–2 hr

Recovery in clinic

When is office hysteroscopy indicated?

Common indications include:

Dysmorphic (T-shaped) uterus — reshaping the cavity to improve implantation potential
Endometrial polyps — removal and histologic assessment
Submucous fibroids (myomas) — resection when appropriate
Uterine septum — division of a septate uterus
Evaluation of abnormal uterine bleeding, recurrent implantation failure, or recurrent pregnancy loss
Removal of retained products of conception or intrauterine adhesions

Why "digital"? Our scope uses a high-definition digital camera that captures the uterine cavity in fine detail, allowing precise identification of subtle findings — including congenital anomalies such as a T-shaped uterus that are frequently missed on 2D ultrasound alone.

Before the procedure

At LIFE by Dr. Pat we use the vaginoscopy (no-touch) technique: no speculum, no tenaculum, and no cervical dilation. Combined with the small-diameter digital scope, this virtually eliminates instrument-related discomfort, so preparation is minimal. Most patients need only routine timing and normal hygiene — very similar to preparing for an ultrasound or a routine internal exam.

Advantages & limitations

A hysteroscope is a slim optical tube of only 3–4 mm in diameter, inserted through the natural cervical canal, so there are no external incisions. The working length inside the body is no more than 10 cm. During the procedure, sterile saline flows through the scope to gently distend the uterine cavity for a clear view and working space.

Advantages

No surgical incisions or scars
No speculum or tenaculum — significantly less pain
Small scope eliminates the need for cervical preparation
Performed in-clinic; no hospital admission required
Lower total cost than operating-room hysteroscopy
Same-day return to normal activities

Limitations

Some pathologies cannot be fully treated at the clinic — for example, intramural or subserosal myomas larger than about 2 cm may require a hospital setting
Very extensive adhesions or bleeding may need conversion to conventional operating-room hysteroscopy

What happens during the procedure

Digital hysteroscopy is performed in two stages:

1. Diagnostic hysteroscopy

Pain during a uterine procedure typically comes from contact between an instrument and the uterine wall. In diagnostic hysteroscopy, saline gently opens the cavity and the scope enters without touching the walls — so pain is very rare.

Because of this, diagnostic hysteroscopy at LIFE by Dr. Pat is performed without sedation. You can watch the exam on a monitor beside the bed, and Dr. Patsama explains each step in real time so you understand what is being assessed and why.

2. Operative hysteroscopy

Once the cavity has been visualized and the pathology confirmed, you will be offered pain relief and light sleep (sedation) before the treatment portion begins. The procedure is video-recorded and a copy is provided to you as part of your medical record.

Most treatments take under 30 minutes. You then rest in the recovery area for 1–2 hours before going home. Light spotting is normal; you can walk and travel the same day.

After hysteroscopy

Aftercare focuses on giving the uterine lining time to heal and preparing the cavity to receive an embryo. Guidance typically includes:

Take prescribed antibiotics and any anti-inflammatory medication as directed
Expect light spotting for a few days — soaked pads or heavy bleeding should be reported
Avoid vaginal intercourse, tampons, tub baths, and swimming for the interval Dr. Patsama specifies
Return for the scheduled follow-up (usually endoscopic re-check or 3D-TVUS) to confirm healing
Resume regular activity, gentle exercise, and normal diet immediately unless otherwise advised

These practices support optimal healing so the uterus is ready for embryo implantation and a healthy pregnancy.

Patient instruction video

Dr. Patsama walks through the vaginoscopy no-touch technique and what to expect during and after your visit.

Watch on YouTube ↗

Reference

Vichinsartvichai P. Congenital Malformation of the Uterus. Bangkok: Printable, 1st printing, June 2022.