Changes in hysteroscopic capabilities have been preceded by technological advances that have enabled them. Modern operative hysteroscopes rely on a variety of different-sized optical, inflow, outflow, and working channels to enable clear visualization of the endometrial cavity as well as the surgical removal of intracavitary lesions such as polyps and myomas. This review examines the relative merits of various hysteroscopic treatment options with a focus on the most recent operative hysteroscopic technique, hysteroscopic morcellation, and how this new technology fits into the armamentarium of the gynecologist.