Complications in operative hysteroscopy – is prevention possible?

Aas-Eng, Mee Kristine; Langebrekke, Anton; Hudelist, Gernot

doi:10.1111/aogs.13209

Cited by 54 publications

(36 citation statements)

References 29 publications

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“…In general, complications of surgical hysteroscopic procedures may include simply, difficulty in entering the internal os, bleeding, cervical laceration, uterine perforation, infection, fluid overload, absorption of irrigation solutions, dilutional hyponatremia, incomplete resection, intrauterine adhesions and, rarely, gas or air embolism (2,9,10). The reported incidence of complications is 1 to 3%, and the majority of these occur during surgical procedures (11).…”

Section: Discussionmentioning

confidence: 99%

Office diagnostic smart hysterofiberscopy, hysmartscopy, using mobile technology: A single center experience and analysis of diagnostic accuracy

et al. 2019

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Office hysteroscopy is a minimally invasive procedure and provides a direct view of the endometrial cavity. This study presents the first report of a novel smartphone-based ultrathin flexible hysterofiberscopy system (currently known as office diagnostic smart hysterofiberscopy, or Hysmartscopy), for the diagnosis of intrauterine abnormalities. The Hysmartscopy system captures images using a flexible fiberscope (0.8 mm in diameter) coupled with an Apple iPhone 6S™.

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Section: Discussionmentioning

confidence: 99%

Office diagnostic smart hysterofiberscopy, hysmartscopy, using mobile technology: A single center experience and analysis of diagnostic accuracy

et al. 2019

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“…Hysteroscopy has revolutionized the treatment of many benign uterine diseases; nevertheless, as with any other type of surgical procedure, there can be complications (1). The difficulties most commonly reported are those related to inserting the hysteroscope through the cervical canal, particularly when cervical dilatation is required to allow the insertion of larger caliber sheaths.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

“…Adequate cervical ripening can reduce the rate of complications associated with the difficulties encountered when inserting the hysteroscope (1,3). The methods used for cervical ripening are based on osmotic dilators (laminaria) and natural and synthetic prostaglandins.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Comparison Between 200 μg and 800 μg of Misoprostol for Cervical Ripening Prior to Operative Hysteroscopy: A Study Protocol for A Randomized Controlled Trial.

Maior¹,

Costa²,

Souza³

2020

Preprint

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Background: Hysteroscopy, a minimally invasive procedure, has been increasingly used to treat disorders of the cervical canal and uterine cavity. However, difficulties related to the insertion of the hysteroscope through the cervical canal still remain. Although there are reported advantages in reducing cervical resistance with the use of misoprostol for cervical ripening, systematic reviews highlight the need to determine the optimal dose. This study was designed to compare two groups of patients submitted to cervical dilatation prior to operative hysteroscopy and pre-treated with either 200 µg or 800 µg of misoprostol for cervical ripening. Methods: A randomized, quadruple-blind clinical trial with patients submitted to cervical dilatation prior to operative hysteroscopy at university teaching hospitals in Recife, Pernambuco, Brazil. After the internal review boards of the participating institutes had approved the study protocol, data collection began on November 7, 2019, with expected completion on November 1, 2020. Patients included in the study following the informed consent process are randomly allocated to one of two groups, the first allocated to use 200 μg misoprostol and the second to use an 800-μg dose. In both groups, misoprostol will be administered vaginally 10-12 hours prior to operative hysteroscopy. The groups will be compared in relation to intraoperative and postoperative outcomes based on the following endpoints: baseline cervical dilatation, cervical length, degree of difficulty, duration of cervical dilatation, failure to dilate, adverse events and surgical complications. The chi-square test of association, Fisher's exact test and the Mann-Whitney test will be used to compare the groups, with an alpha error of <5% being considered significant. Discussion: The findings of this study will contribute towards establishing the optimal misoprostol dose for cervical ripening prior to operative hysteroscopy, ultimately facilitating hysteroscope insertion through the cervical canal. A gap will be filled in the currently available literature, providing future preoperative guidance. The 800-μg dose of misoprostol is expected to reduce resistance in the cervix and shorten the time until achieving cervical dilatation, delivering a less traumatic procedure for the patient. Therefore, the study is relevant for surgeons in this field, for the scientific community and, particularly, for patients. Trial registration: Clinical Trials Register: NCT04152317. Registered on November 5, 2019. URL https://clinicaltrials.gov/ct2/show/study/NCT04152317.

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“…9 The complications of surgical hysteroscopy can be divided into early and late. 10 Among the early complications, excessive bleeding, uterine perforation, postoperative infection and fluid overload can be mentioned. Some studies [11][12][13][14] report that early complications occur in $ 1.0% to 3.6% of the procedures.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with the Complications of Hysteroscopic Myomectomy

Lima

Brito

Baccaro

2020

Rev Bras Ginecol Obstet

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Objective To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. Methods A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. Results We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96–0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18–3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43–5.38). Conclusions Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.

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Complications in operative hysteroscopy – is prevention possible?

Cited by 54 publications

References 29 publications

Office diagnostic smart hysterofiberscopy, hysmartscopy, using mobile technology: A single center experience and analysis of diagnostic accuracy

Office diagnostic smart hysterofiberscopy, hysmartscopy, using mobile technology: A single center experience and analysis of diagnostic accuracy

Comparison Between 200 μg and 800 μg of Misoprostol for Cervical Ripening Prior to Operative Hysteroscopy: A Study Protocol for A Randomized Controlled Trial.

Factors Associated with the Complications of Hysteroscopic Myomectomy

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