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Advanced Hysteroscopic Technology for Gynecological Disease
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Advanced Hysteroscopic Technology for Gynecological Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 February 2026 | Viewed by 2141

Special Issue Editors

Dr. Guglielmo Stabile

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
Interests: hysteroscopy; laparoscopy; endometriosis; oncology; leiomyomas
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Luigi Nappi

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
Interests: hysteroscopy; laparoscopy; endometriosis; oncology; leiomyomas
Special Issues, Collections and Topics in MDPI journals
Dr. Felice Sorrentino

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71122 Foggia, FG, Italy
Interests: gynecological surgery; hysteroscopy; laparoscopy; endometriosis; gynecological oncology; urogynecology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The progress seen in hysteroscopy in the gynecology field is remarkable. More and more pathologies can be diagnosed and treated with the use of hysteroscopy. Furthermore, the instrumental advancement and the improvement of its effectiveness have made hysteroscopy a fundamental tool for treating the majority of endometrial and uterine pathologies.

For this reason, with this Special Issue, we want to focus on the recent development of hysteroscopy in the technological fields and also in the diagnostics and therapeutic management of different uterine pathologies (endometrial pathologies, leiomyomas, isthmocele, uterine septum, ectopic pregnancies, oncological pathologies, endocervical pathologies).

Invited topics are:

  1. New technologies in hysteroscopy.
  2. Advances in the diagnosis of uterine pathologies.
  3. Advances in the treatment of uterine pathologies.
  4. Outcomes after hysteroscopic surgery.
  5. New preoperative therapies.
  6. New methods for pain reduction during outpatient hysteroscopy.
  7. New diagnostic and prognostic biomarkers following endometrial biopsy.

Dr. Guglielmo Stabile
Prof. Dr. Luigi Nappi
Dr. Felice Sorrentino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hysteroscopy
  • new technology
  • therapy
  • mini-invasive approach
  • laser
  • diagnosis
  • outcomes

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Published Papers (3 papers)

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Research

18 pages, 523 KB  
Article
Application of the Analgesia Nociception Index and Visual Analog Scale to Assess Pain During Hysteroscopy Under Local Anesthesia
by Adrian Nowak, Karolina Chmaj-Wierzchowska, Adam Malinger and Maciej Wilczak
J. Clin. Med. 2025, 14(23), 8386; https://doi.org/10.3390/jcm14238386 - 26 Nov 2025
Viewed by 248
Abstract
Background/Objectives: Pain assessment during hysteroscopy facilitates rapid operator intervention (e.g., repeated anesthesia, administration of additional analgesics, or termination of the procedure), thereby improving patient comfort. Traditionally, pain intensity has been evaluated based on the patient’s subjective reporting; however, the introduction of an [...] Read more.
Background/Objectives: Pain assessment during hysteroscopy facilitates rapid operator intervention (e.g., repeated anesthesia, administration of additional analgesics, or termination of the procedure), thereby improving patient comfort. Traditionally, pain intensity has been evaluated based on the patient’s subjective reporting; however, the introduction of an objective indicator in combination with subjective measures can considerably improve pain assessment. In this context, the present study aimed to evaluate pain intensity in patients undergoing hysteroscopy under local anesthesia (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany), with simultaneous assessment using the Visual Analog Scale (VAS) and the Analgesia Nociception Index (ANI). Determining the relationship between ANI and VAS could contribute to improving patient comfort during hysteroscopic procedures performed under local anesthesia. Methods: The study included a total of 221 patients between the ages of 22 and 82 years, divided into two groups: 125 patients underwent diagnostic hysteroscopy (HD) and 96 patients underwent operative hysteroscopy (HO). After the procedure, patients were asked to assess pain intensity by using the VAS. The ANI was also monitored during the procedure. Measurements were conducted immediately before the procedure (T0), at the 1st minute (T1), mid-procedure (T1/2), and at the end of the procedure (T2). Results: The mean pain score in the study group was 3 points (3.04 ± 2.29), with a mean post-procedure score of 2.79 ± 2.19 and 3.36 ± 2.38 in the DH and OH groups, respectively. At Tmean, the ANI values ranged from 42 to 97 points, with a mean value of 70 points (70.37 ± 10.99). All correlations between the ANI values and VAS pain scores were statistically nonsignificant (p > 0.05), with correlation coefficients close to zero. This finding indicates that subjective pain assessment (VAS) does not correspond to the ANI values, which reflects the physiological autonomic response. Conclusions: Further research on pain assessment during hysteroscopy is warranted. Future studies should include larger patient populations, conduct continuous ANI monitoring, and correlate ANI with real-time subjective pain assessments (e.g., VAS during the procedure). The determination of psychological factors, such as pre-procedural anxiety, and the use of additional autonomic nervous system measures (e.g., skin conductance and pupillometry) could facilitate the development of a comprehensive model for objective pain assessment in patients undergoing gynecological procedures through hysteroscopy. Full article
(This article belongs to the Special Issue Advanced Hysteroscopic Technology for Gynecological Disease)
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10 pages, 5192 KB  
Article
Clinical Outcomes After Hysteroscopic Removal of Retained Products of Conception with or Without Prior Uterine Artery Embolization
by Eva Skuk, Polona Vihtelič, Peter Popovič, Kaja Kovač, Ivan Verdenik and Nataša Kenda Šuster
J. Clin. Med. 2025, 14(22), 8020; https://doi.org/10.3390/jcm14228020 - 12 Nov 2025
Viewed by 450
Abstract
Purpose: Retained products of conception (RPOC) are a common complication after pregnancy. While hysteroscopic resection is the standard treatment when RPOC does not resolve spontaneously, highly vascular tissue can lead to severe bleeding during the procedure. This study assessed clinical outcomes, procedural [...] Read more.
Purpose: Retained products of conception (RPOC) are a common complication after pregnancy. While hysteroscopic resection is the standard treatment when RPOC does not resolve spontaneously, highly vascular tissue can lead to severe bleeding during the procedure. This study assessed clinical outcomes, procedural safety, and reproductive performance in patients with highly vascular RPOC treated with uterine artery embolization (UAE) prior to hysteroscopy, compared to those treated with hysteroscopy alone. Methods: This retrospective study included 42 women diagnosed with RPOC at University Medical Centre Ljubljana, Slovenia (2010–2020). Patients were divided into two groups: UAE followed by hysteroscopic resection (UAE + HSC, n = 21) and hysteroscopic resection alone (HSC-only, n = 21). Data on clinical outcomes, complications, and reproductive history were analyzed using Fisher’s exact and t-tests (p < 0.05). Results: Groups were similar in baseline characteristics, except for greater vascularity in the UAE + HSC group (100% vs. 4.8%, p < 0.05). Bleeding >300 mL occurred more often in the UAE + HSC group, but all cases were managed conservatively and only one patient required transfusion. No uterine perforations occurred. Residual RPOC was found in one patient per group. Rates of endometritis, menstrual changes, and pelvic pain were comparable. Among those who attempted conception, live birth and miscarriage rates did not differ significantly. Conclusions: UAE prior to hysteroscopic surgery appears to be a safe and effective option for highly vascular RPOC, especially in patients at risk of hemorrhage, with no adverse impact on fertility. Further prospective studies are recommended. Full article
(This article belongs to the Special Issue Advanced Hysteroscopic Technology for Gynecological Disease)
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14 pages, 490 KB  
Article
Assessment of Pain Complaints and Perioperative and Delayed Complications of Hysteroscopy Performed Under Local Anesthesia—A Retrospective Analysis
by Agnieszka Lach, Maciej Wilczak, Adam Malinger, Adrian Nowak, Piotr Piekarski, Adrian Mruczyński, Kinga Bednarek and Karolina Chmaj-Wierzchowska
J. Clin. Med. 2025, 14(16), 5646; https://doi.org/10.3390/jcm14165646 - 9 Aug 2025
Viewed by 1097
Abstract
Modern, small-diameter endoscopic instruments, such as resectoscopes (e.g., the GUBBINI System) and mini-hysteroscopes, are widely used in clinical practice. These tools allow endoscopic procedures to be conducted without cervical dilation, often in an outpatient setting, and under local anesthesia alone. Background/Objectives: The [...] Read more.
Modern, small-diameter endoscopic instruments, such as resectoscopes (e.g., the GUBBINI System) and mini-hysteroscopes, are widely used in clinical practice. These tools allow endoscopic procedures to be conducted without cervical dilation, often in an outpatient setting, and under local anesthesia alone. Background/Objectives: The present retrospective study aimed to analyze the perioperative and delayed complications of hysteroscopy performed under local anesthesia. This study also assessed the pain experienced during hysteroscopy under local anesthesia, depending on the type of procedure performed. Methods: A retrospective analysis was conducted in 1945 patients who underwent hysteroscopy under local anesthesia at the Center for Hysteroscopy, Heliodor Święcicki Gynecological and Obstetrical Clinical Hospital, Karol Marcinkowski Medical University, Poznań, Poland, between January 2021 and December 2023. Hysteroscopic procedures were performed with the GUBBINI Mini Hystero-Resectoscope through a paracervical block using lignocaine. Results: The procedure was discontinued in 46 patients, accounting for 2.36% of all hysteroscopies. The most common reasons for procedure discontinuation were severe pain and uterine perforation, accounting for 52.8% and 13% of discontinued procedures, respectively. The complication rates were low: uterine perforation occurred in 0.3% of cases (n = 6), and late complications requiring readmission occurred in 0.2% (n = 3). The average pain intensity score for all the patients was 2 points (2.8 ± 2.14). Conclusions: Our study confirmed that hysteroscopy performed under local anesthesia is a safe and effective diagnostic and therapeutic method for selected uterine pathologies, noting increased risks in cases such as extensive intrauterine adhesions. The low complication rates in both the perioperative and postoperative stages indicate the high safety profile of this procedure, particularly when performed by experienced personnel using standardized, validated protocols. Full article
(This article belongs to the Special Issue Advanced Hysteroscopic Technology for Gynecological Disease)
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