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Prise en charge des léiomyomes utérins. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S550-S576. [PMID: 28063565 DOI: 10.1016/j.jogc.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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52
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Roy KK, Metta S, Kansal Y, Kumar S, Singhal S, Vanamail P. A Prospective Randomized Study Comparing Unipolar Versus Bipolar Hysteroscopic Myomectomy in Infertile Women. J Hum Reprod Sci 2017; 10:185-193. [PMID: 29142447 PMCID: PMC5672724 DOI: 10.4103/jhrs.jhrs_134_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Study Objective: To compare the operative and reproductive outcome of hysteroscopic myomectomy using unipolar resectoscope versus bipolar resectoscope in patients with infertility and menorrhagia. Design: Randomized, prospective, parallel, comparative, single-blinded study. Design Classification: Canadian Task Force classification I. Setting: Tertiary care institute. Patients: Sixty women with submucous myoma and infertility. Interventions: Hysteroscopic myomectomy performed with unipolar resectoscope or bipolar resectoscope. Measurements: Primary outcome measures were the pregnancy-related indicators. Secondary outcome measures were the operative parameters, harmful outcomes related to the procedure, and comparison of improvement levels in the menstrual pattern after surgery between the two groups. Main Results: A total of 60 patients were randomized into two groups of equal size. Baseline characteristics were not significantly different between the two groups. Reduction in sodium level from pre- to postsurgery was significantly (P = 0.001) higher in the unipolar group. Nine patients (30%) in the unipolar group had hyponatremia in the postoperative period compared to none in the bipolar group (P = 0.002). However, there was no significant difference in the other operative parameters between the two groups. In both the groups, a significant improvement in the menstrual symptoms was observed after myomectomy. Pregnancy-related outcomes were similar in both the groups. Conclusion: The use of bipolar resectoscope for hysteroscopic myomectomy is associated with lesser risk of hyponatremia compared to unipolar resectoscope. Bipolar resectoscopic myomectomy is found to be an effective and safer alternative to unipolar resectoscopy with similar reproductive outcome.
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Affiliation(s)
- Kallol K Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Metta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Yamini Kansal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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53
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Johansson J, Lindahl M, Gyllencreutz E, Hahn RG. Symptomatic absorption of isotonic saline during transcervical endometrial resection. Acta Anaesthesiol Scand 2017; 61:121-124. [PMID: 27918101 DOI: 10.1111/aas.12834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J Johansson
- Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care, Unit of Research, Education and Development - Östersund, Umeå University, Umeå, Sweden
| | - M Lindahl
- Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
| | - E Gyllencreutz
- Department of Obstetrics and Gynecology, Östersund Hospital, Östersund, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - R G Hahn
- Research Unit, Södertälje Hospital, Södertälje, Sweden
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54
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Umranikar S, Clark TJ, Saridogan E, Miligkos D, Arambage K, Torbe E, Campo R, Sardo ADS, Tanos V, Grimbizis G. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. ACTA ACUST UNITED AC 2016; 13:289-303. [PMID: 28003797 PMCID: PMC5133285 DOI: 10.1007/s10397-016-0983-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Vasilios Tanos
- St’ Georges Med School, Nicosia University and Aretaeio Hospital, Nicosia, Cyprus
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55
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Abstract
Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.
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56
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57
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Sultan SS. Combined hyponatremia and hypocalcemia after intravascular absorption of 1.5% glycine during operative hysteroscopy. A case report. EGYPTIAN JOURNAL OF ANAESTHESIA 2016. [DOI: 10.1016/j.egja.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sherif S. Sultan
- International Medical Center (IMC), P.O. Box 2172, Jeddah, 21451, Saudi Arabia
- Department of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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58
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The Role of Hysteroscopic and Robot-assisted Laparoscopic Myomectomy in the Setting of Infertility. Clin Obstet Gynecol 2016; 59:53-65. [DOI: 10.1097/grf.0000000000000161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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59
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Saridogan E. Surgical treatment of fibroids in heavy menstrual bleeding. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:53-62. [PMID: 26693796 PMCID: PMC5779570 DOI: 10.2217/whe.15.89] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uterine fibroids can cause abnormal uterine bleeding and their removal is beneficial in the treatment of heavy menstrual bleeding associated with fibroids for women who would like to preserve their uterus and fertility. Endoscopic (hysteroscopic and laparoscopic) approaches are the preferred methods of fibroid removal when appropriate. In the presence of submucosal fibroids, hysteroscopic resection is a simple, safe and effective treatment for heavy menstrual bleeding and reduces the need for more major surgery, such as hysterectomy. When abdominal myomectomy is required, laparoscopic myomectomy is the preferred choice in selected cases due to its advantages over open myomectomy.
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Affiliation(s)
- Ertan Saridogan
- Women's Health Division, University College London Hospitals, 250 Euston Road, London, NW1 2PG, UK
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60
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Noel NL, Isaacson KB. Morcellation complications: From direct trauma to inoculation. Best Pract Res Clin Obstet Gynaecol 2015; 35:37-43. [PMID: 26879674 DOI: 10.1016/j.bpobgyn.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/30/2022]
Abstract
Morcellation is the fragmentation of tissue to facilitate removal of the specimen through small incision in minimally invasive surgery. This technique is not unique to gynecology and is used in general surgery with the goal of improved surgical outcomes including decreased pain, cost, hospital length of stay, and rapid return to normal activities and work. Gynecologic laparoscopic power morcellation (LPM) has come under increased scrutiny over the last 2 years due to widespread attention to a known but rare complication, an unanticipated dissemination of malignancy, namely occult uterine leiomyosarcoma. This chapter focuses on complications associated with gynecologic tissue morcellation from inoculation of benign or malignant tissue fragments within the peritoneal cavity and direct trauma from morcellation techniques. We also include a review of the various morcellation techniques from knife to electrical and the use of intraperitoneal specimen containment systems.
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Affiliation(s)
- Nyia L Noel
- Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA.
| | - Keith B Isaacson
- Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA.
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61
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Nikolopoulos I, Phillips G. Reliability of fluid monitoring during operative hysteroscopy. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s10397-015-0922-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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62
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Seet MJ, Lau MS, Chan JK, Tan HH. Management of complete vagino-uterine septum in patients seeking fertility: Report of two cases and review of literature. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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63
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Closon F, Tulandi T. Future research and developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol 2015; 29:994-1000. [DOI: 10.1016/j.bpobgyn.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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64
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New technologies and innovations in hysteroscopy. Best Pract Res Clin Obstet Gynaecol 2015; 29:951-65. [DOI: 10.1016/j.bpobgyn.2015.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/18/2015] [Indexed: 11/18/2022]
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65
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Complications of hysteroscopy and how to avoid them. Best Pract Res Clin Obstet Gynaecol 2015; 29:982-93. [DOI: 10.1016/j.bpobgyn.2015.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
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66
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Choudhary D, Sethi P, Sharma V, Bhatia PK. Glycine induced retinotoxicity is avoidable. Indian J Anaesth 2015; 59:531. [PMID: 26379309 PMCID: PMC4551043 DOI: 10.4103/0019-5049.163015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepak Choudhary
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
| | - Priyanka Sethi
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
| | - Vandana Sharma
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
| | - Pradeep Kumar Bhatia
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
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67
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Ting WH, Lin HH, Wu MP, Tu FC, Peng FS, Hsiao SM. Safety and efficacy of manual syringe infusion of distending media for hysteroscopic procedures: a case-control study. Eur J Obstet Gynecol Reprod Biol 2015; 191:112-5. [PMID: 26115055 DOI: 10.1016/j.ejogrb.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/26/2015] [Accepted: 06/03/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Adverse events associated with large volumes of distending media in hysteroscopic procedures can be life-threatening. The aim of this study was to evaluate the safety and efficacy of manual syringe infusion (MI) of distending media for hysteroscopic procedures. STUDY DESIGN Between January 2011 and December 2013, the medical records of all women who underwent hysteroscopic procedures using MI or the conventional pump-infusion method (PI, the control group) were reviewed. The Wilcoxon rank-sum test, the Chi-square test and the multivariate logistic regression analysis were employed for statistical analysis. RESULTS The MI group (n=82) had a significantly lower average volume of infused fluid (1117 ± 712 mL vs. 2216 ± 1502 mL, respectively; p<0.001), less operative time (22.2 ± 9.7 vs. 30.4 ± 9.8 min, respectively; p<0.001) and lower postoperative abdominal pain scores (0.6 ± 0.7 vs. 0.8 ± 0.7, respectively; p=0.04) than the PI group (n=58). Subgroup analysis of women who underwent hysteroscopic myomectomy revealed a significantly lower amount of infused fluid for the MI group than for the PI group (1737 ± 905 mL vs. 3441 ± 1952 mL, respectively; p=0.001). Infused fluid amount (coefficient=0.08, p<0.001) was the only significant independent factor affecting fluid deficit, with a constant of 76.1. CONCLUSION The MI method appears to be a safe and feasible method for delivering distending media during hysteroscopic procedures.
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Affiliation(s)
- Wan-Hua Ting
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei City, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan; Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Fung-Chao Tu
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan
| | - Fu-Shiang Peng
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan.
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68
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Hepp P, Jüttner T, Beyer I, Fehm T, Janni W, Monaca E. Rapid correction of severe hyponatremia after hysteroscopic surgery – a case report. BMC Anesthesiol 2015; 15:85. [PMID: 26051404 PMCID: PMC4459668 DOI: 10.1186/s12871-015-0070-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/29/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND One of the most feared complications during hysteroscopic surgery is haemodilution by absorption of distension media. One facet of haemodilution, i.e. hyponatremia, can lead to respiratory distress, pulmonary oedema, as well as cardiovascular collapse. CASE PRESENTATION Here we report the swift recovery of a 45 year, female, Caucasian patient with acute hyponatremia (74 mEq/L) and pulmonary oedema by the employment of rapid correctional strategies. CONCLUSION The absorption of irrigation fluids, as presented in this case, is an inevitable side effect of hysteroscopic surgery. Utmost caution should, therefore, be mandatory to reduce and actively monitor fluid intake. If these measures fail, as in the case presented here, it is essential to rapidly eliminate any free water and to normalize the sodium levels. Anecdotal reports of pontine myelinolysis are not in line with literature concerning acute hyponatremia and should, therefore, not obstruct determined action against it.
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Affiliation(s)
- Philip Hepp
- Clinic for gynecology and obstetrics, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, North Rhine-Westphalia, Germany.
| | - Tobias Jüttner
- Clinic for anesthesiology, Klinikum Wolfenbüttel, Wolfenbüttel, Lower Saxony, Germany.
| | - Ines Beyer
- Clinic for gynecology and obstetrics, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, North Rhine-Westphalia, Germany.
| | - Tanja Fehm
- Clinic for gynecology and obstetrics, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, North Rhine-Westphalia, Germany.
| | - Wolfgang Janni
- Clinic for gynecology and obstetrics, University Ulm, Ulm, Baden-Württemberg, Germany.
| | - Enrico Monaca
- Clinic for anesthesiology, Heinrich-Heine-University, Düsseldorf, North Rhine-Westphalia, Germany.
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70
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Abstract
Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.
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Affiliation(s)
- Mark M Erian
- Teaching and Research Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Glenda R McLaren
- University of Queensland and Mater Mothers Hospital, Brisbane, Australia
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71
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Harpham M, Abbott J. Use of a Hysteroscopic Morcellator to Resect Miscarriage in a Woman With Recurrent Asherman's Syndrome. J Minim Invasive Gynecol 2014; 21:1118-20. [DOI: 10.1016/j.jmig.2014.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/17/2014] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
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72
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Overdijk LE, van Kesteren PJM, de Haan P, Schellekens NCJ, Dijksman LM, Hovius MC, van den Berg RG, Bakkum EA, Rademaker BMP. Carboxyhaemoglobin formation and ECG changes during hysteroscopic surgery, transurethral prostatectomy and tonsillectomy using bipolar diathermy. Anaesthesia 2014; 70:296-303. [PMID: 25346445 DOI: 10.1111/anae.12877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 12/01/2022]
Abstract
Diathermy is known to produce a mixture of waste products including carbon monoxide. During transcervical hysteroscopic surgery, carbon monoxide might enter the circulation leading to the formation of carboxyhaemoglobin. In 20 patients scheduled for transcervical hysteroscopic resection of myoma or endometrium, carboxyhaemoglobin was measured before and at the end of the surgical procedure, and compared with levels measured in 20 patients during transurethral prostatectomy, and in 20 patients during tonsillectomy. Haemodynamic data, including ST-segment changes, were recorded. Levels of carboxyhaemoglobin increased significantly during hysteroscopic surgery from median (IQR [range]) 1.0% (0.7-1.4 [0.5-4.9])% to 3.5% (2.0-6.1 [1.3-10.3]%, p < 0.001), compared with levels during prostatectomy or tonsillectomy. Significant ST-segment changes were observed in 50% of the patients during hysteroscopic surgery. Significant correlations were observed between the increase in carboxyhaemoglobin and the maximum ST-segment change (ρ = -0.707, p < 0.01), between the increase in carboxyhaemoglobin and intravasation (ρ = 0.625; p < 0.01), and between intravasation and the maximum ST-segment change (ρ = -0.761; p < 0.01). The increased carboxyhaemoglobin levels during hysteroscopic surgery appear to be related to the amount of intravasation and this could potentially be a contributing factor to the observed ST-segment changes.
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Affiliation(s)
- L E Overdijk
- Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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73
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Deffieux X, Ménager N, Gauthier T, Legendre G, Agostini A, Pierre F. [Methods used to provide guidelines for clinical practice concerning the prevention of the complications related to hysteroscopy]. ACTA ACUST UNITED AC 2013; 42:1028-31. [PMID: 24210237 DOI: 10.1016/j.jgyn.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
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74
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[Prevention of the complications related to hysteroscopy: guidelines for clinical practice]. ACTA ACUST UNITED AC 2013; 42:1032-49. [PMID: 24210234 DOI: 10.1016/j.jgyn.2013.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To provide clinical practice guidelines (CPGs) from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning the adverse events related to hysteroscopy. MATERIALS AND METHODS Review of literature using following Keywords: hysteroscopy; vaginoscopy; infection; perforation; intrauterine adhesions RESULTS Vaginoscopy should be the standard technique for outpatient hysteroscopy (grade A) using a miniature (≤ 3.5mm sheath) (grade A) rigid hysteroscope (grade C), using normal saline solution distension medium (grade C), without any anesthesia (conscious sedation should not be routinely used), without cervical preparation (grade B), without vaginal disinfection and without antibiotic prophylaxy (grade B). Misoprostol (grade A), vaginal estrogens (grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120 mmHg. The maximum fluid deficit of 2000 mL is suggested when using normal saline solution and 1000 mL is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (grade B). CONCLUSION Implementation of this guideline should decrease the prevalence of complications related to office and operative hysteroscopy.
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75
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Abbott J. Letter to the editor. J Minim Invasive Gynecol 2013; 20:728-9. [PMID: 23811382 DOI: 10.1016/j.jmig.2013.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/26/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Jason Abbott
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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