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

Abstract

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.

Operative Hysteroscopy Complications

“…It is the second most common complication after entry-related complications, with rates varying between 0,16% and 0,61% in published reports [5,36,37]. Higher incidence rates are described for adhesiolysis (2.51%) and myomectomies that involve intramural components (3-4%) [38,39].…”

“…In 2018, ISGE/BSGE joint guideline on fluid management for hysteroscopy, defined fluid overload as a fluid deficit of more than 1000 ml with hypotonic solutions and 2500 ml when using isotonic solutions [45]. Risk factors that increase fluid intravasation include high intrauterine distension pressure, low mean arterial pressure, prolonged surgery, extensive surgical resection and large uterine cavities [39]. Elderly women with cardiovascular, renal or other medical comorbidities are also at a higher risk.…”

“…Treatment involves laparoscopic salpingectomy and hysteroscopic adhesiolysis to prevent further cornual hematometra recurring. Salpingectomy should be performed bilaterally as there are reports of contra-lateral recurrence [39]. In cases of recurring pelvic pain, consideration should be given to a hysterectomy.…”

Часові Критерії Безпечності Виконання Гістерорезектоскопічної Міомектомії При Одиночній Субмукозній Міомі Матки

“…Показник дефіциту розчину вважається ключовим параметром оцін-ки безпечності резекції субмукозної міоми матки [1,4,11,14]. За умови регламентованого діапазо-ну внутрішньоматкового тиску (70-130 мм рт.…”

“…Загальноприйнято вважати пороговим дефі-цит 1000 мл розчину, тоді як показник 1500 мл є критичним і потребує негайного прийняття рі-шення щодо перспективи завершення резекції субмукозної міоми [4,9,11,12,14]. Максимально допустимою, за рекомендацією ААGL від 2012 ро-ку, є інтравазація 2500 мл промивного розчину.…”