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Learn and Love fine art of intrauterine surgery The untold secrets to master the art! In this video , please observe and watch the following; 1) Concept of vaginoscopy was introduced in late nineties to facilitate office hysteroscopy without using vaginal speculum neither painful traction on cervix. In the classic article published upon Vaginoscopy technique, described insertion of hysteroscope via vagina till reach posterior fornix , then pull back little to see external os. however, never described real endoscopic examination of the vagina. Hence, it was just vaginoscopic access to uterine cavity. You can see this step clearly in the start of video and how to reach external OS. However, FDA Vginoscopy is absolutely different concept and different objective. FDA , Fluid distension Assited vaginoscopy is simply manual closure of vulva by gentle pressure with fingers to maintain proper distension of Vagina. This allows a fabulous vision and opportunity to examine all details of vaginal cavity as well as the cervix. Lot of findings can be elicited by this simple and very comfortable technique. 2) Insertion via cervical canal, you should be very slow and not like insertion of a dilator. Slow insertion give chance for proper fluid hydro dilatation and clear cervical mucous and avoid foggy view during insertion. Never move forward till you have that tunnel view. Slight corkscrew rotation facilitate advance forward without friction. 3) Use proper fluid pressure whatever high to dilate the cervical canal. The fluid pressure is your dilator, then decrease pressure as soon as you enter uterine cavity. Hence using pressure is changeable and dynamic not fixed level as been fought fro long time. 4) During pass through cervical canal, maintain a view of anterior wall of cervixc and internal os crescent shape not full circle. this is due to the nature of 30 degree angle lens. 5) To inspect and view lateral sides and posterior aspect, you should rotate the lens by rotation the light cable or all system camera and lens. Rotatory movement generated by wrist and slow. Never move telescope from side to side. I hope this video demonstration and my tips will help you to enjoy performing Hysteroscopy always. Osama Shawki Prof of Gynecology Cairo university Director HART Hysteroscopy Academy for Research and Training