Experience with Isotonic 2.2% Glycine as Distension Medium for Hysteroscopic Endomyometrial Resection

Abstract

The feasibility of performing hysteroscopic endomyometrial resection using isotonic 2.2% glycine as distension medium was studied in 181 consecutive operations. A standard continuous flow loop-resectoscope was used. Distension was achieved by means of a gravity-fed system and glycine flowed out under its own pressure. The mean (±SEM) glycine deficit was 160 ± 20 ml and in only 7 patients was it >1 liter (maximum 1,800 ml). Only in patients with >1 liter glycine absorption was there a significant decrease in serum sodium level (mean 9 mmol/l), while serum osmolality remained normal. Apart from 1 case of transient nausea, these patients had no sequelae. We experienced isotonic 2.2% glycine as a useful and safe distending medium for operative hysteroscopy.

Endometrial thermoablation for treatment of menorrhagia: comparison of two methods in outpatient setting

“…Hysteroscopic endometrial resection using glycine as a distension medium has been used in Finland by Tapper and Heinonen with good clinical outcome (14,15); this procedure, however, requires experience in operative hysteroscopy by the gynecologist. Glycine may also be absorbed during the procedure, which may have undesired effects such as changes in serum osmolality and electrolyte levels (16). In our experience, thermoablation is a fast treatment with good patient compliance.…”

Hysteroscopic Complications

“…Glycine 2.2% absorbed in greater than 1 liter amounts has been associated with decreased serum sodium with normal osmalality [10, 11]. Glycine intravasation may lead to hyperammonemic encephalopathy, with transient blindness and memory loss.…”

“…Excessive fluid absorption or idiosyncratic reactions to distending media can occur during either diagnostic or operative hysteroscopy. The ideal distending medium does not exist; therefore, the hysteroscopist is left with several choices of media, each with certain advantages [6,7,8,9,10,11, 12,13, 14]. But certain general concepts pervade the use of any distending medium.The operating time is important because more fluid absorption occurs during lengthier cases.…”

“…The most commonly used fluids are 5% or 10% dextrose and water, Ringer's lactate, normal saline, 1.5% glycine, 3% sorbitol, 5% mannitol, and 2.8% sorbital/0.5% mannitol in combination. Intravasation or sensitivity reaction complications have been reported with all these media [6,7,8,9,10,11,12,13,14,15,16,17]. Complications of low-viscosity media are related most often to intravasation of the distending media.…”

“…It has been recommended that when these levels are reached, the patient's serum electrolytes be measured and loop diuretics given [18]. Glycine 2.2% absorbed in greater than 1 liter amounts has been associated with decreased serum sodium with normal osmalality [10,11]. Glycine intravasation may lead to hyperammonemic encephalopathy, with transient blindness and memory loss.…”