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Chapter-08 Complications of hysteroscopic surgery – how to avoid and manage

BOOK TITLE: Minimally Invasive Gynecologic Surgery: Evidence-Based Laparoscopic, Hysteroscopic and Robotic Procedures

Author
1. Herendael Bruno van
2. Bosteels Jan
ISBN
9781909836099
DOI
10.5005/jp/books/12892_9
Edition
1/e
Publishing Year
2016
Pages
6
Author Affiliations
1. ZNA Stuivenberg, Lange Beeldekensstraat, Antwerpen, Belgium, ZNA Stuivenberg – St Erasmus, Antwerp, Belgium
2. Imelda Ziekenhuis, Bonheiden, Belgium
Chapter keywords
isotonic electrolytic, nonelectrolytic fluids, symptomatic hematometra, cervical laceration, hematocrit, pathophysiology, cardiovascular collapse, myocardial infarction, electrosurgical instruments, hysteroscopic myomectomy, intrauterine adhesions, operative procedures, troublesome complications, excessive intravasation

Abstract

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.

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