Energy systems for operative hysteroscopy

Many patients with excessive or abnormal uterine bleeding are looking for alternatives to ineffectual dilation and curettage or extirpative surgery (i.e., hysterectomy). The gynecologist-generalist can no longer delay developing the mandatory skills to perform safe, effectual intrauterine surgery. To acquire these skills, one needs a sound understanding of hysteroscopic instrumentation and the biophysical behavior of available energy modalities. This article reviews the scientific basis for operative hysteroscopic procedures using laser energy and monopolar and bipolar electrosurgery.