This chapter discusses complications of hysteroscopic surgery, where most hysteroscopic procedures are done using fluid distension media. Complications of hysteroscopic surgery may be due to patient positioning, anesthesia, access problems, the use of distending media, gas emboli, perforation of the uterine wall, bleeding, the use of electrosurgical instruments, infection, or may be caused by the formation of intrauterine adhesions. The use of distension media in hysteroscopic surgery enables to convert the virtual cavity of the uterus to a suitable working space by overcoming the resistance of the uterine musculature. Traumatic injuries caused by hysteroscopy are more frequent during operative hysteroscopy than diagnostic procedures because more dilatation is necessary for the introduction of the larger caliber hysteroscopes. Intra- or postoperative bleeding is the most common complication of hysteroscopic surgery. The use of an automated fluid management is highly recommended in operative hysteroscopy. The surgical team needs to monitor accurately the fluid input and output.