Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial

Dyrbye, Birgitte A.; Overdijk, Lucilla E.; Kesteren, P. J. M. van; Haan, Peter; Riezebos, Robert K.; Bakkum, Erica A.; Rademaker, B. M. P.

doi:10.1016/j.ajog.2012.07.027

Cited by 38 publications

(53 citation statements)

References 18 publications

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“…TEE-guided studies proved air bubbles during hysteroscopic surgery to occur in 98% of observed patients, without clinical repercussions [3]. Another paper found 85% of operative hysteroscopy patients to exhibit a continuous flow of bubbles through the right ventricle, again without clear clinical signs of an adverse event [2].…”

Section: Discussionmentioning

confidence: 99%

“…Dyrbye et al [3] studied the relation of VAE to the usage of mono-or bipolar coagulation. They concluded that the use of bipolar coagulation was associated with larger air bubbles and that intravasation of volumes exceeding 1,000 mL was associated with emboli of higher clinical significance.…”

Section: Discussionmentioning

confidence: 99%

“…Transesophageal echocardiography (TEE)-guided studies have shown that VAE occurs in the majority of operative hysteroscopies [2,3]. However, these studies have also suggested that these emboli are only rarely clinically significant.…”

Section: Introductionmentioning

confidence: 99%

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Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Dijck

Rex²,

Verguts³

et al. 2017

Gynecol Obstet Invest

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Venous air embolism (VAE) is a rare but potentially fatal complication of hysteroscopic myomectomy. The symptoms of VAE range from mild and clinically insignificant to complete cardiovascular collapse during surgery. Anesthesiologists and surgeons should be aware of the clinical characteristics and predisposing factors of this possible adverse event. This report analyzes 7 cases of VAE, which occurred at the University Hospitals Leuven, in patients undergoing hysteroscopic myomectomy from April 2009 to April 2011. Patient and myoma characteristics were compared to a control group of 27 patients who underwent uneventful hysteroscopic myomectomy during the same period of time. Analysis of baseline data including myoma size failed to identify predisposing factors. Clinical events in this series were classified according to their severity as minor (causing respiratory symptoms in 2 cases), moderate (accompanied by hemodynamic instability in 5 cases), or severe (requiring resuscitation in no cases). Case characteristics and therapeutic strategies in all cases were compared to reports from recent literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Dijck

Rex²,

Verguts³

et al. 2017

Gynecol Obstet Invest

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“…multiple myomatosis or large/ample adhesiolysis). However, this safety should not be overestimated because cardiovascular disturbances that indicate gaseous embolism during transcervical resection of myomas may occur despite the limitation of intravasation 32 even if bipolar diathermia is used 25 . There are uncommon uterine conditions, which can predispose patients to massive absorption and fluid overload.…”

Section: Discussionmentioning

confidence: 99%

“…In endoscopic resections, both monopolar (which needs non-electrolytic solutions as distension fluid) or bipolar (more expensive technique, which accepts electrolytic/ ionic solutions 19,20 ) probes can be used for performing hysteroscopic adhesiolysis, resection of uterine septum, endometrium, polyps and fibroids 10,13,[21][22][23][24] . In fact, both techniques have been widely used over the last decade 14,25,26 . Recently, we have hypothesized that endoscopic surgeries with bipolar energy are associated with higher absorption of irrigation fluid due to higher permissibility of pressure and surgical time when an electrolytic solution is used.…”

Section: Introductionmentioning

confidence: 99%

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases

Fonseca¹,

Andrade²,

Nogueira³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To verify the predictors of intravasation rate during hysteroscopy. METHODS: Prospective observational study (Canadian Task Force classification II-1). All cases (n=200 women; 22 to 86 years old) were treated in an operating room setting. Considering respective bag overfill to calculate water balance, we tested two multiple linear regression models: one for total intravasation (mL) and the other for absorption rate (mL.min -1). The predictors tested (independent variables) were energy (mono/bipolar), tube patency (with/without tubal ligation), hysterometry (cm), age≤50 years, body surface area (m 2 ), surgical complexity (with/without myomectomy) and duration (min). RESULTS: Mean intravasation was significantly higher when myomectomy was performed (442±616 versus 223±332 mL; p<0.01). In the proposed multiple linear regression models for total intravasation (adjusted R 2 =0.44; p<0.01), the only significant predictors were myomectomy and duration (p<0.01).In the proposed model for intravasation rate (R 2 =0.39; p<0.01), only myomectomy and hysterometry were significant predictors (p=0.02 and p<0.01, respectively). CONCLUSIONS: Not only myomectomy but also hysterometry were significant predictors of intravasation rate during operative hysteroscopy. ResumoOBJETIVO: Testar preditores do ritmo de intravasamento durante histeroscopia cirúrgica. MÉTODOS: Estudo prospectivo observacional (classificação: Canadian Task Force II-1) incluindo casos conduzidos em centro cirúrgico (n=200 mulheres; 22 a 86 anos de idade). Considerando os erros de aferição nas embalagens de solução de irrigação para calcular o balanço hídrico, nós testamos dois modelos de regressão linear múltipla: um para intravasamento total (mL) e outro para ritmo de intravasamento (mL.min -1 ). Os preditores testados (variáveis independentes) foram energia (mono/ bipolar), permeabilidade tubária (com/sem ligadura tubária), histerometria (cm), status ovariano (idade≤50 anos), área de superfície corporal (m 2 ), complexidade de cirurgia (com/sem miomectomia) e tempo de ressecção (min). RESULTADOS: O intravasamento médio foi significativamente maior quando miomectomia foi realizada (442±616 versus 223±332 mL, p<0,01). No modelo proposto para intravasamento total (R 2 ajustado=0,44; p<0,01), os únicos preditores significativos foram miomectomia e tempo de duração (p<0,01). No modelo proposto para a taxa de intravasamento (R 2 =0,39; p<0,01), somente miomectomia e histerometria foram preditores significativos (p=0,02 e p<0,01, respectivamente). CONCLUSÕES: Não só a miomectomia mas também a histerometria são preditores significativo da taxa de intravasamento durante histeroscopia cirúrgica.

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Effects of different fractions of inspired oxygen on gas embolization during hysteroscopic surgery: A double‐blind, randomized, controlled trial

Deng,

Zhou,

Diao

et al. 2023

Intl J Gynecology & Obste

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ObjectiveGas embolism is a common complication of hysteroscopic surgery that causes serious concern among gynecologists and anesthesiologists due to the potential risk to patients. The factors influencing gas embolism in hysteroscopic surgery have been extensively studied. However, the effect of the oxygen concentration inhaled by patients on gas embolism during hysteroscopic surgery remains elusive. Therefore, we designed a double‐blind, randomized, controlled trial to determine whether different inhaled oxygen concentrations influence the occurrence of gas embolism during hysteroscopic surgery.MethodsThis trial enrolled 162 adult patients undergoing elective hysteroscopic surgery who were randomly divided into three groups with inspired oxygen fractions of 30%, 50%, and 100%. Transthoracic echocardiography (four‐chamber view) was used to evaluate whether gas embolism occurred. Before the start of surgery, the four‐chamber view was continuously monitored.ResultsThe number of gas embolisms in the 30%, 50%, and 100% groups was 36 (69.2%), 30 (55.6%), and 24 (44.4%), respectively. The incidence of gas embolism gradually decreased with increasing inhaled oxygen concentration (P = 0.031).ConclusionIn hysteroscopic surgery, a higher oxygen concentration inhaled by patients may reduce the incidence of gas embolism, indicating that a higher inhaled oxygen concentration, especially 100%, could be recommended for patients during hysteroscopic surgery.Trial RegistrationChinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=53779, Registration number: ChiCTR2000033202).

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Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial

Cited by 38 publications

References 18 publications

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases

Effects of different fractions of inspired oxygen on gas embolization during hysteroscopic surgery: A double‐blind, randomized, controlled trial

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