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The advantage of using the feroblique hysterscope is that the uterine cavity is this roundish cavity and ideally what you want to try to do is cause minimal trauma, using that 30-degree angle and rotating rather than torquing around the cervix. The more you can rotate, the less trauma you do and the better your visualization is, especially when you get into the office setting, because patients do not tolerate this type of motion around the cervix well at all.
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You almost always ought to have some sort of back up; I have had my instruments dropped, broken, everything that can possibly go wrong has gone wrong. It is worthwhile to check the instruments before surgery. I have had resectoscopes that if you look at the common resectoscope, at least the unipolar one, at the end of the resectoscope is a little ceramic sheath which protects the metal resectoscope and the loop, which you are going to have electrical surgical current going through, from touching one another. I can tell you that at least once in my career, the ceramic tip had been completely broken off. That is a very dangerous situation, if I happen to stick that instrument in without looking at it. I could have easily burned the patient.
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Dilators can traumatize tissue. If you are doing an office hysteroscopy, that is a problem. Ideally, you like to get in with a 3-mm, 4-mm or less instrument. We have very nice, very small hysteroscopes that you can get into almost any cervix besides the most stenotic cervix, without dilation. It is worthwhile to try to do that first, to try to visualize. Most of the hysteroscopes come with these inserts that are very hard and rigid. I don’t usually those; I usually look at the canal and follow the canal on up and then pop into the uterine cavity. You want to stay away from the side walls, but again, that will create bleeding.