Safety Issues of Hysteroscopic Surgery

Abstract

The term hysteroscopy is used to determine the procedure during which an endoscopic view of the endometrial cavity is achieved with the help of a type of endoscopic device called "the hysteroscope." Hysteroscopy is used to assist the diagnosis for a series of female pathology. Apart from its diagnostic value, hysteroscopy can also be used for operative procedures including ablation and resection. Both diagnostic and operative hysteroscopy have been used for a number of years and various studies have been published to describe their success and complication rates throughout this period. Diagnostic hysteroscopy is relatively safe, whereas complications occur more frequently when operative hysteroscopy is used. These complications include uterine perforation, hemorrhage, fluid overload, gas embolization, and hyponatremia. The rate in the appearance of these complications is dependent on the type of the hysteroscopic procedure, the distending medium, and the experience of the hysteroscopist. To avoid any problems concerning the application of hysteroscopic procedures, it is important to take the necessary precautions both preoperatively and intraoperatively. For example, the preoperative use of thinning agents of the endometrium and the reduction of the operating time, or the avoidance of cutting too deeply into the myometrium, are some of the parameters to be considered when hysteroscopy is in argument.

Safety and efficacy of manual syringe infusion of distending media for hysteroscopic procedures: a case–control study

“…For operative procedures using monopolar electrosurgical instruments, an electrolyte-free media is required to avoid thermal injury, whereas in bipolar electrosurgical procedures, isotonic electrolyte-rich solutions are useful and safer media [1]. Adverse events associated with large volumes of distending media in hysteroscopic procedures can be life-threatening [2,3]. Regardless of the type of distending media used, excess absorption of fluid media may result in dilutional hyponatremia.…”

Proposal of a modified transcervical endometrial resection (TCER) technique for menorrhagia treatment. Feasibility, efficacy, and patients’ acceptability

“…None of the patients were found to have intrauterine adhesions Fig. 3 A narrowing of the cavity is evidenced at 60 months but it does not hinder to evaluate the entire cavity, including the cornual area sometime associated to clinical problems, like surgical (perforation of the uterus), vascular complications or fluid overload syndrome [5][6][7][8][9][10][11][12]. Moreover, like resectoscopic myomectomy, TCER is a surgical procedure suggested only to experienced surgeons [19].…”

“…Matter of discussion related to TCER is also the putative occurrence of other problems related to the endometrial injury, as in the case of immediate (vascular or metabolic type complications (fluid overload) and perforation), or delayed complications (as in the case of the development of partial intrauterine dense adhesions and/or total obliteration of the cavity) [5][6][7][8][9][10][11][12]. Therefore, the ideal method of TCER associating high efficacy to nice tolerability and low incidence of complications is still far from being achieved.…”

Abdominal compartment syndrome occurring due to uterine perforation during a hysteroscopy procedure

“…Fluid volume overload, uterine perforation, hemorrhage, bowel and urinary tract injuries, and gas embolization have occurred in fewer than 1% of procedures according to one survey [1,2]. The most frequent reported complication was uterine perforation, but this did not always cause significant problems [3].…”