Hysteroscopy has evolved from a mere observational tool for "peering into the uterine cavity" into a minimally invasive precision instrument that integrates accurate diagnosis and treatment with fertility preservation. Over the past three decades, under the leadership of senior experts like Professor Xia Enlan, the field has forged a distinctive path centered on "safety as the foundation, innovation as the guide, and fertility preservation as the priority". As the year draws to a close, Obstetrics and Gynecology Network has invited Professor Feng Limin from Beijing Tiantan Hospital, Capital Medical University, to draw on her decades of clinical experience to systematically review the developments, key breakthroughs, and future directions of hysteroscopic technology this year, aiming to provide a reference for the continuous advancement of gynecological hysteroscopy.
When discussing the development and future trends of hysteroscopy, Professor Feng Limin pointed out that the conference held by the Taiwan Endoscopic Association of China this year offered an insightful perspective. At the meeting, the President of the Taiwan Endoscopic Association noted: over the past 30 years, laparoscopy has been the mainstay of minimally invasive technology; however, in the next 10 years, the focus may shift to hysteroscopy. This is closely linked to the current global backdrop of declining fertility. As fertility rates continue to drop, "preserving fertility and promoting reproductive health" has become a common goal and direction of efforts worldwide. China has further incorporated improving fertility into its national strategy, and a recent meeting of the State Council explicitly proposed increasing support for enhancing fertility. These policy orientations and technical support will undoubtedly set the priorities for future work.
From the "Cradle of Life" to an "Evolutionary Proposition": Medicine Must Safeguard the Essence of Human Reproduction
Despite the current downward trend in fertility rates and the rapid advancement of science and technology, in the field of reproductive health related to hysteroscopy, the female uterus remains irreplaceable as the only natural organ for human reproduction to date. This inevitably sparks the question: Can robots replace the uterus in nurturing life in the future? When addressing this issue, clinicians should focus on "benefits to future generations". Without the unique physiological changes during female pregnancy, what challenges would the nutrition acquisition and developmental support of offspring face? Of course, we believe that the future world will be transformed by technological progress, but such transformation must be based on full consideration of the essence of life.
As the saying goes, "Only by living longer can we witness the future". Nevertheless, regardless of technological evolution, human reproduction and the progress of civilization are irreversible trends. A major proposition that future medicine must confront is to better conform to and safeguard the inherent nature of life while exploring possibilities.
From the Evolution of Energy-Free Instruments to the Core Shift Toward Fertility Preservation
Looking back at the development of hysteroscopy in China, over the past 30 years, under the leadership of Professor Xia Enlan, colleagues dedicated to hysteroscopy have truly rooted and expanded the diagnosis and treatment of intrauterine diseases across all aspects of gynecology. From the gradual improvement of early equipment and continuous refinement of operational techniques to the constant updating of core concepts, the diagnosis and treatment of intrauterine diseases have become increasingly convenient and effective. Throughout this process, safety has always been a top priority—only by adhering to the bottom line of safety can convenience and efficiency be meaningful.
In recent years, much of the industry's discussion on technological transformation has centered on the evolution of instruments. Domestically, it is customarily referred to as "cold knife technology", but internationally, the more accurate term is energy-free instruments. In 2025, led by Professor Xia Enlan, the Chinese Expert Recommendations on the Clinical Application of Energy-Free Hysteroscopic Technology was released, systematically expounding on the correct understanding and application of energy-free instruments. In fact, the development of energy-free instruments epitomizes the progress of the entire field of gynecological minimally invasive surgery.
Looking back, hysteroscopy first allowed direct visualization of intrauterine lesions, with early findings mostly being endometrial polyps. At that time, small forceps were used to obtain biopsies, which served as the prototype of the so-called "cold knives" later on. However, limited by their small size and insufficient spring tension, these forceps yielded small tissue samples and were prone to damage, hindering their popularization. It was not until the rise of laparoscopic technology— which has become capable of handling most routine gynecological procedures and even some malignant tumor surgeries over 30 years—that people realized that the forceps used in mini laparoscopy could also be applied to intrauterine operations. Thus, "cold knife instruments", or energy-free instruments, gradually entered the field of hysteroscopy. Based on such practical experience, the formulation of the Chinese Expert Recommendations on the Clinical Application of Energy-Free Hysteroscopic Technology has clarified the surgical indications, operational methods, perioperative management, and access requirements for energy-free instruments.
It should be emphasized that energy-free instruments are not a panacea and cannot replace all procedures; they must be used in conjunction with energy-based instruments. The choice between the two does not depend on the physician's personal preference or the patient's condition alone, but on which method is safer and more effective for the specific lesion—that is the true criterion for instrument selection. The original intention of widely using energy-free instruments is to better protect the endometrium and preserve the uterus' future function. As for the choice in specific cases, physicians need to rely on extensive experience to make decisions. Just as a gynecologist who is not proficient in laparotomy would lack the confidence to attempt radical hysterectomy for cervical cancer and such an attempt would also violate teaching principles, the learning of hysteroscopy must proceed from basics to advanced levels in a steady manner.
It is also important to emphasize that hysteroscopy is first and foremost a diagnostic tool, and image recognition capability is particularly crucial. For example, in colposcopy training, hundreds of devices displaying various typical and variant images are arranged in a training space of over 100 square meters, and trainees are required to make clear diagnoses after observation. Similarly, the interpretation of hysteroscopic image changes and morphological features relies on extensive experience accumulation to lay a reliable foundation for subsequent treatment. This is similar to children's cognitive education: a child who has only seen tables and chairs at home can still distinguish that chairs are for sitting while tables are not when encountering different styles in society. Similarly, we should establish a clear understanding of abnormal uterine cavity morphology through continuous surgical observation and the study of atlases and monographs, and combine this with practical operations to make accurate diagnoses. Without a profound understanding of images and relying solely on mechanical operations, it will be difficult to make a definite diagnosis, let alone formulate an appropriate treatment plan.
The Era of Fertility Preservation: The Transformation from "Treating Diseases" to "Full-Cycle Management"
With the continuous improvement of public health standards, the number of visits for common gynecological diseases should theoretically show a downward trend, which itself reflects the progress of medical standards. However, the reality is that we are entering an era of "delayed fertility", a trend not only in China but also globally. On the surface, the declining fertility rate has led to a decrease in the number of patients in obstetrics, neonatology, and some pediatric departments. At the same time, the delay in childbearing age and insufficient fertility reserve have placed higher demands on reproductive health services, especially among elderly pregnant women. To address this contradiction, we need to invest more systematic and in-depth attention in the field of reproductive health and establish a multi-dimensional response strategy.
First, we must not only deepen the development of basic disciplines such as reproductive surgery and reproductive endocrinology, but also strengthen the connection with assisted reproductive technologies, and strive to improve the management capabilities for high-risk pregnant women to ensure their safe delivery.
Second, it should be clear that advancing these fields cannot be achieved merely by "observing a few surgeries", but must rely on comprehensive management. Taking clinically intractable conditions such as intrauterine adhesions and uterine malformations as examples, treatment should not stop at "surgical resection", but require overall planning: when to perform reconstructive surgery, when to promote rapid endometrial growth, when to connect with assisted reproduction, and when to collaborate with obstetrics for safe delivery. These links are interrelated and require gynecologists to work together across stages and disciplines.
In addition, contemporary fertility issues are often intertwined with various medical comorbidities, such as hematological diseases and cardiovascular and cerebrovascular diseases, which may have a profound impact on pregnancy outcomes. This requires physicians to conduct a careful assessment of the patient's overall condition at the first visit: we must not ignore the bottom line of maternal and fetal safety in the name of "preserving fertility", otherwise, we will put patients at risk. Therefore, every obstetrician and gynecologist should possess a broader general medical perspective and comprehensive judgment capabilities to help elderly women or those with comorbidities complete pregnancy safely, thereby contributing to the "Healthy China" and "Healthy Reproduction" strategies.
Conclusion
In 2025, China's hysteroscopic technology has continued to innovate based on the experience of predecessors, achieved breakthroughs in increasingly standardized practices, and firmly locked onto the fundamental mission of "guarding the origin of life" amid the global focus on fertility preservation. In the future, we need to continue to take "safety" as the cornerstone, "precision" as the direction, and "humanity" as the core, promoting the resonance between technological innovation and the laws of life. May every hysteroscopic operation not only cure diseases but also serve as a bridge to sustain the hope of life.
Expert Profile
Professor Feng Limin
Beijing Tiantan Hospital, Capital Medical UniversitySecond-Class Professor,Chief Physician
Doctoral SupervisorStanding Committee Member
Chinese Medical Doctor Association Obstetrics and Gynecology BranchChairperson,Committee for Prevention and Treatment of Intrauterine Diseases
China Maternal and Child Health Association Chairperson, Hysteroscopy GroupVice Chairperson, Beijing Obstetrics and Gynecology Branch, Chinese Medical AssociationVice Chairperson, Department of Obstetrics and Gynecology, Capital Medical UniversityVice Chairperson, Gynecology Professional Branch, China County Hospital Presidents AllianceVice Chairperson, Laparoscopic and Endoscopic Surgery Branch, China International Exchange and Promotion Association for Medical and HealthcareExecutive Director, Beijing Medical Women's Association;
Vice Chairperson, Bethune Foundation Management CommitteeExecutive Member, Gynecologic Oncology Branch, Beijing Obstetrics and Gynecology Society, Chinese Medical AssociationExecutive Member, Beijing Obstetrics and Gynecology Branch, Beijing Medical AssociationExecutive Member, Laparoscopic and Endoscopic Branch, China International Exchange and Promotion Association for Medical and HealthcareExecutive Member, Gynecology Professional Committee, Cross-Strait Medical and Health Exchange AssociationExecutive Member,
China International Exchange and Promotion Association for Medical and HealthcareExecutive Member, Obstetrics and Gynecology Professional Committee
China Medical Device Industry AssociationExecutive Member, Reproductive Tract Disease Diagnosis and Treatment Branch
China Eugenic Science Association Executive Member, Medical Science Popularization Branch, Beijing Medical Doctor AssociationMember, Obstetrics and Gynecology Professional Committee
Beijing Resident Standardized Training CommitteeEditorial Board Member of Chinese Journal of Obstetrics and Gynecology Clinical, Chinese Journal of Minimally Invasive Surgery, Journal of Capital Medical University, International Journal of Obstetrics and Gynecology, Chinese Journal of Family Planning and Obstetrics & Gynecology, Chinese Journal of Laparoscopic and Endoscopic Surgery, etc.
Editor: Ma Ye