Hysteroscopic Complications

Abstract

Diagnostic and operative hysteroscopic procedures are performed to evaluate women with abnormal uterine bleeding structural uterine anomalies. Diagnostic and minimally invasive hysteroscopic surgical procedures in the hands of well-trained, experienced hysteroscopists offer little chance of serious complications. More extensive procedures offer greater risks, with fluid overload being the most common. The well-prepared and experienced hysteroscopic surgeon should have the ability, equipment, ancillary personnel, and facilities to prevent and to treat this problem, as well as the knowledge necessary to handle mechanical accidents, anesthetic complications, and post-procedure infections. The greatest risk in this procedure is, as always, an inadequately trained or ill-prepared operator.

Comparison of transvaginal sonography with hysteroscopy and correlation with histopathological report in case of abnormal uterine bleeding

“…9 However, diagnostic hysteroscopy is an invasive and costly procedure which may be associated with risks such as uterine perforation and ascending genito-urinary infection. 10,11 Furthermore, it provides only subjective assessment of fibroid size and indirect information regarding the depth of myometrial extension.…”

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

“…Besides transurethral resection of the prostate, operative hysteroscopy (OH) is an endoscopic surgery in which undesirable absorption of irrigation fluids is a major risk factor for complications [1][2][3][4][5] . Distension media, if absorbed systemically in sufficient amounts, can trigger adverse events, including life-threatening complications.…”

Modeling intravasation of liquid distension media in surgical simulators

“…Excess absorption of the distention fluid is one of the most serious complications in resectoscopy and is called fluid overload syndrome (FOS) (Rassweiler et al, 2006;Pasini and Belloni, 2001;Julian, 2002). FOS occurs when too much electrolyte-free distention fluid is pressed through iatrogenically opened vessels into the patient's vascular system, a process called intravasation.…”

“…Procedures placing the patient at high risk for intravasation include hysteroscopic resection of myoma and uterine septa (Pasini and Belloni, 2001). Risk levels can be reduced by increasing the surgeon's efficiency, and by decreasing the length of the surgery, the amount of distension fluid infused, and the anesthesia time (Julian, 2002). While there are recommendations for the maximal fluid loss (800-1200 ml) and operation time (30-60 min) in medical literature (Köchli et al, 2000;Nesrin et al, 2002;Julian, 2002), the actual occurrence of fluid overload is mostly unexpected for both surgeons and anesthetists.…”

“…Risk levels can be reduced by increasing the surgeon's efficiency, and by decreasing the length of the surgery, the amount of distension fluid infused, and the anesthesia time (Julian, 2002). While there are recommendations for the maximal fluid loss (800-1200 ml) and operation time (30-60 min) in medical literature (Köchli et al, 2000;Nesrin et al, 2002;Julian, 2002), the actual occurrence of fluid overload is mostly unexpected for both surgeons and anesthetists. Therefore, intrauterine pressure must be appropriately controlled to maintain a balance between too much pressure, increasing intravasation, and too little pressure, decreasing visibility.…”