Safe and Effective Hysteroscopy in High-Risk Patients: The Role of Ultrasound Guidance

INTRODUCTION: Hysteroscopy is a common minor gynecologic procedure performed for a variety of clinical indications. While considered low risk, it has potential to have significant complications following uterine perforation or having an elevated fluid deficit. This video examines a case for a patient who had a history of a uterine perforation at time of a prior hysteroscopy ultimately leading to a bowel resection. She presented to our office with postmenopausal bleeding and desired surgical management. OBJECTIVE: The objectives of this video are to highlight the benefit of using ultrasound guidance at time of hysteroscopy. METHODS: Ultrasound guidance was used during the case previously outlined with standard hysteroscopy technique. RESULTS: Hysteroscopy was successfully performed with polypectomy under ultrasound guidance. CONCLUSIONS: This case highlights how ultrasound-guided hysteroscopy can be a practical and effective technique for increasing safety and precision—particularly in high-risk patients with prior surgical complications or altered anatomy.