Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Abstract

Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.

Surgical Management of Leiomyomas for Fertility or Uterine Preservation

“…35 Careful monitoring of the fluid deficit with an automated fluid measurement system is recommended. 32 Several are commercially available. 32 A fluid deficit of 750 mL of nonelectrolyte solution during surgery should signal planned termination of the procedure.…”

“…Visualization is especially challenging during activation of the mechanical device and requires experience. 32 Dilation of the cervix is performed before insertion of the hysteroscope. Before the procedure, misoprostol may be inserted vaginally to allow easier dilation (offlabel use).…”

Safety and efficacy of manual syringe infusion of distending media for hysteroscopic procedures: a case–control study

“…Regardless of the type of distending media used, excess absorption of fluid media may result in dilutional hyponatremia. Patients can develop right-sided heart failure or pulmonary and cerebral oedema, sometimes resulting in death [3]. Therefore, minimizing the systemic absorption of the distending media is an important measure in reducing mediarelated hysteroscopy complications.…”

“…For operative procedures using monopolar electrosurgical instruments, an electrolyte-free media is required to avoid thermal injury, whereas in bipolar electrosurgical procedures, isotonic electrolyte-rich solutions are useful and safer media [1]. Adverse events associated with large volumes of distending media in hysteroscopic procedures can be life-threatening [2,3]. Regardless of the type of distending media used, excess absorption of fluid media may result in dilutional hyponatremia.…”

Complications of hysteroscopy and how to avoid them

“…Ideally, the distension media should be at the lowest level that provides adequate distension with an intrauterine pressure of approximately 70e100 mmHg. This is usually achieved when the media is suspended approximately 1e1.5 m above the uterus [23,24].…”