Pharmacologic Interventions to Minimize Fluid Absorption at the Time of Hysteroscopy

Desilets, J.; Zakhari, Andrew; Chagnon, Miguel; Ekmekjian, Taline; Nguyen, Dong Bach; Smith, Jessica Papillon; Mansour, Fady; Krishnamurthy, Srinivasan

doi:10.1097/aog.0000000000005051

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2024

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Good practice with fluid management in operative hysteroscopy

Vilos,

Abu‐Rafea

et al. 2024

Intl J Gynecology & Obste

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Hysteroscopic surgery requires a balance of continuous controlled irrigation and aspiration to distend the endometrial cavity to a degree that provides the clear and stable visual environment necessary for diagnostic and therapeutic procedures. Whereas the preferred distending solution should be isotonic and isonatremic, radiofrequency (RF) electrosurgery with monopolar instrumentation can only be performed with non‐ionic (hyponatremic) solutions. Absorption of as little as 500 mL and certainly more than 1000 mL of non‐ionic solutions can result in fluid overload and/or dilutional hyponatremia with potentially serious adverse effects under certain conditions and patient characteristics. Both hysteroscopic RF electrosurgery with bipolar instrumentation and electro‐mechanical morcellation and aspiration systems use isotonic and isonatremic solutions. Depending on the clinical context, absorption of more than 1500 mL of isonatremic solutions can also result in serious adverse effects. Automated fluid management systems are preferred and recommended, and surgeons should aim to maintain the maximum allowable intravasation of distending media below 1000 and 1500 mL for non‐ionic and ionic fluids, respectively.

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