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Amirkhanloo F, Haddadi M, Ebrahimi M. Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures. Clin Case Rep 2024; 12:e9060. [PMID: 38947538 PMCID: PMC11211086 DOI: 10.1002/ccr3.9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Cesarean scar pregnancy cases who undergo hysteroscopic suction aspiration could be at higher risk of air emboli due to dilated, low-resistant, high-velocity blood vessels.
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Affiliation(s)
- Fatemeh Amirkhanloo
- IVF Unit, Obstetrics and Gynecology WardYas Hospital Complex, Tehran University of Medical SciencesTehranIran
| | - Mohammad Haddadi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Mahbod Ebrahimi
- IVF Unit, Obstetrics and Gynecology WardYas Hospital Complex, Tehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
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2
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Yong J, Wan Y, Ye M, Yi S, Zeng F, Sun X, Song J, Wang X, Zeng X, Xiao S. Comparative analysis of the clinical efficacy and reproductive outcomes of the hysteroscopic tissue removal system (MyoSure) and hysteroscopic electroresection in the treatment of benign intrauterine lesions. Int J Gynaecol Obstet 2023; 163:115-122. [PMID: 37211662 DOI: 10.1002/ijgo.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/19/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare and analyze the clinical efficacy and reproductive outcomes of the hysteroscopic tissue removal system (MyoSure) and hysteroscopic electroresection in the treatment of benign intrauterine lesions in women of reproductive age. METHODS This is a retrospective study of patients with benign intrauterine lesions treated with MyoSure or hysteroscopic electroresection. The primary outcomes were operative time and resection completeness, and reproductive outcomes were followed up and compared. Secondary outcomes included perioperative adverse events and postoperative adhesions seen during second-look hysteroscopy. Data analysis was performed using χ2 and Fisher tests for qualitative variables and Student t-test for quantitative variables. RESULTS The operative times of patients with type 0 or I myoma, endometrial polyps, or retained products of conception in the MyoSure group were shorter than those in the electroresection group but were not significantly different for patients with type II myomas. The complete resection rate was lower in the MyoSure group than in the electroresection group. The degree of decrease in the American Fertility Society score of intrauterine adhesion in the MyoSure group was significantly higher (2.90 ± 1.29 points vs 1.31 ± 0.89 points, P = 0.025). The time to pregnancy and the pregnancy rate were higher in the MyoSure group (13.14 ± 7.85 months vs 16.26 ± 8.22 months, P = 0.040; 65.12% vs 54.55%, P = 0.045), but there was no significant difference in the term live birth rate, premature birth rate, or abortion rate between the two groups. CONCLUSION MyoSure has advantages of a shortened operative time and improvement in reproductive outcomes such as pregnancy rate. However, for type II myomas, MyoSure has limitations, and a comprehensive evaluation before the procedure is required.
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Affiliation(s)
- Jiahui Yong
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Yajun Wan
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Mingzhu Ye
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuijing Yi
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Zeng
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xin Sun
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jiarui Song
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xinyu Wang
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyang Zeng
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
| | - Songshu Xiao
- Department of Gynecology and Obstetrics, Third Xiangya Hospital, Central South University, Changsha, China
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Vitale SG, Della Corte L, Ciebiera M, Carugno J, Riemma G, Lasmar RB, Lasmar BP, Kahramanoglu I, Urman B, Mikuš M, De Angelis C, Török P, Angioni S. Hysteroscopic Endometrial Ablation: From Indications to Instrumentation and Techniques-A Call to Action. Diagnostics (Basel) 2023; 13:diagnostics13030339. [PMID: 36766443 PMCID: PMC9914843 DOI: 10.3390/diagnostics13030339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
The development of minimally invasive techniques has led to the creation of innovative alternatives in cases where traditional methods are not applicable. In modern gynecology, hysteroscopy has become the gold standard for the evaluation and treatment of intrauterine pathology. Endometrial ablation (EA) is a procedure that uses different types of energy to destroy the endometrium and is currently used as an alternative technique in cases of heavy menstrual bleeding when medical treatment has failed and uterine preservation is desired. The aim of this review was to evaluate the feasibility, safety, and clinical outcomes of hysteroscopic EA as an alternative in patients with abnormal uterine bleeding. A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane Library), from 1994 to June 2022, to evaluate the outcomes in patients with abnormal uterine bleeding (AUB) undergoing EA using hysteroscopic and non-hysteroscopic techniques. Only scientific publications in English were included. Twelve articles on the current use of endometrial ablation were included. Data on patient symptoms, tools used for EA, primary outcomes, and adverse events were recorded. EA should be considered an effective and safe approach in the management of patients with abnormal uterine bleeding caused by benign pathology, in whom medical treatment has failed or is contraindicated. Due to the lack of evidence, it would be interesting to determine whether EA would also have a role in the treatment of women with premalignant lesions, avoiding invasive surgical procedures or medical treatment in those patients for whom hysterectomy or the use of hormonal treatment is contraindicated.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-3479354575
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00189 Warsaw, Poland
| | - Josè Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Ricardo Bassil Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
| | - Bernardo Portugal Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, 34010 Istanbul, Turkey
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000 Zagreb, Croatia
| | - Carlo De Angelis
- Department of Maternal and Child Health and Urological Sciences, “Sapienza“ University of Rome, 00185 Rome, Italy
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Kovalak EE. Does “no-touch” technique hysteroscopy increase the risk of infection? Turk J Obstet Gynecol 2022; 19:145-151. [PMID: 35770455 PMCID: PMC9249365 DOI: 10.4274/tjod.galenos.2022.04272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Today, thanks to its many advantages, hysteroscopy with a vaginoscopic approach (no-touch) is increasingly being used more in outpatient diagnoses and treatments. However, there are concerns that the “no-touch” technique increases ascending genital tract infections since a speculum is not inserted, and disinfection of the cervix cannot achieve. Materials and Methods: Between 2011 and 2017, 302 patients who underwent office hysteroscopy with the vaginoscopic approach (group 1) and 254 patients who underwent hysteroscopy with the standard method under anesthesia in the operating room (group 2) were compared in terms of early complications (within two weeks postoperatively). The primary outcome was early postoperative infection, and the secondary outcome was other early complications, such as bleeding and rupture. Results: In this study, the success rate of hysteroscopy with the vaginoscopic approach was 96.4%. According to the visual analog scale scoring system, 88.7% of the patients described mild-to-moderate pain. When group 1 and 2 were compared in terms of postoperative infection (3% and 2.4%, respectively) and other early complication rates (0% and 0.8%, respectively), no statistically significant difference was found (p>0.05). Conclusion: Hysteroscopy with a vaginoscopic approach continues to be the gold standard method that is safe and well-tolerated by patients.
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Belouad M, Benlghazi A, Belkouchi L, Bouhtouri Y, Benali S, Kouach J. Septic shock following operative hysteroscopy in a menopausal woman: A case report and review of the literature. Gynecol Minim Invasive Ther 2022; 12:55-57. [PMID: 37025447 PMCID: PMC10071870 DOI: 10.4103/gmit.gmit_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
Minimally invasive gynecologic surgery such as hysteroscopy has a low risk of complications. Infections, however, are more common in the presence of risk factors such as smoking, history of pelvic inflammatory disease, and endometriosis. We report the case of a patient who underwent operative hysteroscopy without immediate complications and was admitted 2 days later to the emergency department in a severe state of septic shock. With multiple organ failures requiring admission to an intensive care unit, the patient died despite extensive antibiotic therapy and vasoactive drugs. Ascending infection can be a potentially fatal complication of hysteroscopy, even in the absence of known risk factors.
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Vilà Famada A, Cos Plans R, Costa Canals L, Rojas Torrijos M, Rodríguez Vicente A, Bainac Albadalejo A. Outcomes of surgical hysteroscopy: 25 years of observational study. J OBSTET GYNAECOL 2021; 42:1365-1369. [PMID: 34913810 DOI: 10.1080/01443615.2021.1971176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this prospective study was to analyse the complications of operative hysteroscopy over the last 25 years and determine whether such complications were related to patient characteristics, surgery type, surgical time or distension-medium balance. Three thousand and sixty-three operative hysteroscopies were performed; 52.7% were polypectomies and 31.5% were myomectomies. Myectomies had the highest incidence of complications, at 14%, followed by septolysis, at 6.9%. The most common complications were mechanical (52%). Myomectomies had seven times higher risk than polypectomies of distension-medium complications (RR 7.5, p<.001) but three times lower risk of mechanical complications (RR 0.32, p<.001). The highest incidence of complications occurred in type I myomas and those larger than 3 cm. If we define fluid-balance complications as only those patients who absorbed more than 1.5 L and developed related symptoms, our overall complication rate, including all mechanical complications, was 5.6%.Impact StatementWhat is already known on this subject? In recent years, the importance of properly preventing and managing hysteroscopic complications has risen in line with the number of diagnostic and operative hysteroscopies performed. Complications in operative hysteroscopy differ between surgery types, patient characteristics and the distending media used.What do the results of this study add? This study provides data from a high number of patients compared to previously published studies on the complications of operative hysteroscopies, and includes a study of the relationship between type of surgery and type of complication.What are the implications of these findings for clinical practice and/or further research? Our study shows the importance of a good preoperative assessment, since the complications of hysteroscopy differ greatly depending on the indication. Thus, within myomectomies, knowing the exact type, size and location of the myoma will allow the surgeon to carefully plan the procedure to avoid complications.
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Affiliation(s)
- Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Ramon Cos Plans
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Costa Canals
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Rojas Torrijos
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Agueda Rodríguez Vicente
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
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Ratner RT, Tsaltas J, Vollenhoven B. Hysteroscopy and the risk of gas embolism: A review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519872407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hysteroscopy is one of the most frequent procedures that a gynecologist will perform over their career. It is also one of the safest procedures. Operative hysteroscopy has an increased risk profile due to the nature of the surgery. The following review will address the issue of gas embolism in hysteroscopy. This review will look at the evidence regarding the likely causation, rates, and potential methods of minimizing risk to patients as well as treatment options available should this complication arise.
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Affiliation(s)
- Roni T Ratner
- Gynaecological Endoscopy and Endometriosis Surgery, Monash Health and Monash University, Bentleigh East, VIC, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery, Monash Health and Monash University, Bentleigh East, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Beverley Vollenhoven
- Women’s and Newborn Programme, Monash Health, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Monash IVF Group, Melbourne, VIC, Australia
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8
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Vilos GA, Hutson JR, Singh IS, Giannakopoulos F, Rafea BA, Vilos AG. Venous Gas Embolism during Hysteroscopic Endometrial Ablation: Report of 5 Cases and Review of the Literature. J Minim Invasive Gynecol 2020; 27:748-754. [DOI: 10.1016/j.jmig.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
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Haude O, Overdijk LE, Kesteren PJM, Geerts BF, Rademaker BMP. Comparing volumetric and biochemical assessment of intravasation caused by hysteroscopic surgery. Acta Anaesthesiol Scand 2020; 64:232-237. [PMID: 31650527 DOI: 10.1111/aas.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND During hysteroscopic surgery intravasation of irrigation fluid occurs, leading to potentially dangerous intravascular fluid overload. Currently, intravasation is usually measured volumetrically as fluid deficit. Intravasation could also be calculated using the decrease in hemoglobin or increase in chloride ion concentration, both phenomena known to result from intravasation. We compared the values of intravasation measured volumetrically as fluid deficit versus calculated from the biochemical change in hemoglobin and chloride. We expected that these values would show strong correlation and agreement. METHODS In a retrospective data analysis of 51 patients who underwent hysteroscopic resection of myomas or endometrium a pre and post procedure concentration of haemoglobin and chloride was available. The fluid deficit was plotted against the two versions of calculated intravasation. Furthermore, we put the data into Bland-Altman plots to scrutinize their relationship. RESULTS The volumetric assessed fluid deficit and both versions of biochemically assessed intravasation, either using the change in hemoglobin or chloride ion concentration, turned out to be three totally different entities with weak correlation. Bland-Altman plots show too wide limits of agreement, and a striking difference between the two methods of calculated intravasation. CONCLUSION Our study shows significant differences and poor agreement between volumetric and biochemically assessed intravasation. Based on this study, routinely assessing intravasation by biochemical methods does not have additional benefit compared to the volumetric fluid deficit. It remains unclear which method resembles true intravasation.
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Affiliation(s)
- Oscar Haude
- Intern, Emergency Department and Intensive Care ADRZ Hospital Goes The Netherlands
| | | | | | - Bart F. Geerts
- Department of Anaesthesia Amsterdam University Medical Center (location AMC) Amsterdam The Netherlands
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Azrai Abu M, Kah Teik C, Ahmad MF, Abdul Ghani NA, Mohamed Ismail NA. Tubo-ovarian abscesses complicated with septic shock following operative hysteroscopy. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.18.04002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Costescu D, Guilbert É. No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:750-783. [PMID: 29861084 DOI: 10.1016/j.jogc.2017.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care. INTENDED USERS Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs. TARGET POPULATION Women with an unintended or abnormal first or second trimester pregnancy. EVIDENCE PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched. VALUES The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request. BENEFITS, HARMS, AND/OR COSTS IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.
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Gupta N, Gupta A. Complications during hysteroscopy for gynecological procedures: prevention is better than cure! Korean J Anesthesiol 2019; 73:79-80. [PMID: 31426625 PMCID: PMC7000280 DOI: 10.4097/kja.19339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences,, New Delhi, India
| | - Anju Gupta
- Department of Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Soljačić Vraneš H, Djaković I, Kraljević Z, Nakić Radoš S, Leniček T, Kuna K. CLINICAL VALUE OF TRANSVAGINAL ULTRASONOGRAPHY IN COMPARISON TO HYSTEROSCOPY WITH HISTOPATHOLOGIC EXAMINATION IN DIAGNOSING ENDOMETRIAL ABNORMALITIES. Acta Clin Croat 2019; 58:249-254. [PMID: 31819320 DOI: 10.20471/acc.2019.58.02.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of our retrospective study was to compare the performance of transvaginal sonography in relation to histologic diagnosis of samples obtained by hysteroscopy through analysis of data collected over 16 years. Data on suspected formation of endometrial polyp or submucosal fibroid found on ultrasound examination were extracted. The study included a total of 3679 women examined during the 2000-2015 period. All women underwent ultrasound examination preoperatively for better planning the type and scope of operation to be performed. The study included only women with samples for histopathologic analysis collected during the operation. Ultrasound diagnosis of polyps compared with histology showed 89.6% sensitivity and 39.1% specificity. For submucosal myomas, sensitivity was 69.2% and specificity 91.3%. In conclusion, ultrasound is not reliable method for definitive diagnosis but it is an excellent orientation method.
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Affiliation(s)
| | - Ivka Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Zdenko Kraljević
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandra Nakić Radoš
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tanja Leniček
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Krunoslav Kuna
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychology, Catholic University of Croatia, Zagreb, Croatia; 3Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Gupta N, Gupta A. Commentary: Venous air embolism during hysteroscopy: A stitch in time saves nine! J Anaesthesiol Clin Pharmacol 2019; 35:417-420. [PMID: 31543605 PMCID: PMC6748011 DOI: 10.4103/joacp.joacp_352_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Anju Gupta
- Department of Anesthesiology and Critical Care, Safdarjung Hospital and VMMC, New Delhi, India
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15
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The case against endometrial ablation for treatment of heavy menstrual bleeding. Curr Opin Obstet Gynecol 2018; 30:287-292. [DOI: 10.1097/gco.0000000000000463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Dealberti D, Riboni F, Vitale SG, Vitagliano A, Santangelo F, Zizolfi B. A Polypectomy Nearly Becoming a Tragedy: A Case of Multiorgan Perforation. J Minim Invasive Gynecol 2018; 25:763-764. [DOI: 10.1016/j.jmig.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/15/2022]
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No 360 - Avortement provoqué : avortement chirurgical et méthodes médicales au deuxième trimestre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:784-821. [DOI: 10.1016/j.jogc.2018.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Overdijk LE, Rademaker BMP, van Kesteren PJM, de Haan P, Riezebos RK, Haude OCH. The HYSTER study: the effect of intracervically administered terlipressin versus placebo on the number of gaseous emboli and fluid intravasation during hysteroscopic surgery: study protocol for a randomized controlled clinical trial. Trials 2018; 19:107. [PMID: 29444699 PMCID: PMC5813421 DOI: 10.1186/s13063-018-2442-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Transcervical resection of myoma or endometrium is a safe, hysteroscopic, minimally invasive procedure. However, intravasation of distension fluid is a common phenomenon during these procedures. In a previous study we observed venous gas emboli in almost every patient. The severity of hysteroscopic-derived embolization has been shown to be correlated to the amount of intravasation. In addition, paradoxical gas embolism, which is potentially dangerous, was observed in several patients. Studies have shown a reduction of intravasation by using intracervically administered vasopressin during hysteroscopy. We think that its analog, terlipressin, should have the same effect. In our previous research we observed more gaseous emboli as intravasation increased. Whether or not the insertion of intracervically administered terlipressin leads to a lower incidence and severity of gas embolism is unknown. We hypothesize that intracervically administered terlipressin leads to a reduction of intravasation with a lower incidence and severity of gas embolism. Terlipressin may be of benefit during hysteroscopic surgery. Methods/design Forty-eight patients (ASA 1 or 2) scheduled for transcervical resection of large, types 1–2 myoma or extensive endometrium resection will be included. In a double-blind fashion patients will be randomized 1:1 according to surgical treatment using either intracervically administered terlipressin or placebo. Transesophageal echocardiography will be used to observe and record embolic events. A pre- and post-procedure venous blood sample will be taken to calculate intravasation based on hemodilution. Our primary endpoint will be how terlipressin influences the severity of embolic events. Secondary endpoints include the effect of terlipressin on the amount of intravasation and on hemodynamic parameters. Discussion If terlipressin does indeed reduce the number of gaseous emboli and intravasation occurring during hysteroscopic surgery, it would be a simple method to minimize potential adverse events. It also allows for prolonged operating time before the threshold of intravasation is reached, thereby reducing the need for a second operation. Trial registration Nederlands Trial Register (Dutch Trial Register), ID: NTR5577. Registered retrospectively on 18 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2442-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Peter de Haan
- OLVG Hospital, Oosterparkstraat 9, 1091 AC, Amsterdam, Netherlands
| | | | - Oscar C H Haude
- University of Amsterdam/AMC Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Liu SQ, Zhao SZ, Li ZW, Lv SP, Liu YQ, Li Y. Monitoring of Gas Emboli During Hysteroscopic Surgery: A Prospective Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:749-756. [PMID: 28150413 DOI: 10.7863/ultra.16.03051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Previous studies have demonstrated a high frequency of gas emboli during hysteroscopy, but guidelines for the prevention, early detection, and intervention of gas embolism during hysteroscopic procedures are still lacking. This study aimed to gain a clearer understanding of risk factors and specific signs and symptoms associated with gas emboli. METHODS This prospective study enrolled 120 women scheduled for hysteroscopy using 5% glucose as distension medium. The gas bubbles were monitored sequentially in internal iliac vein, common iliac vein, inferior vena cava, superior vena cava, heart, and pulmonary artery under the gray-scale imaging of Doppler ultrasound. The frequency, extent, and the hemodynamic and respiratory effects of gas emboli were evaluated. The interventions and outcomes were recorded. The risk factors associated with gas emboli, and their relationship with the frequency and extent of gas emboli, were assessed. RESULTS In our study, evidence of gas emboli under Doppler ultrasound monitoring was observed in 44 (36.7%) patients. The operation was continued and finished as soon as possible for patients presenting with stable vital signs or transient hemodynamic and respiratory changes, which resolved spontaneously without intervention. The operation was paused for patients presenting with significant hemodynamic changes or loss of consciousness, and the operation was resumed shortly after resumption of stable vital signs following symptomatic treatment. All patients in our study finished the operation and recovered without developing serious complications. Data analysis showed prolonged procedure duration and increased bleeding volume were both positively correlated with the frequency and extent of gas emboli. CONCLUSION Our study demonstrated a high frequency of gas emboli during hysteroscopy. Doppler ultrasonic monitoring combined with a clearer understanding of specific signs, symptoms, and risk factors will facilitate early detection and intervention of gas emboli during hysteroscopy.
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Affiliation(s)
- Sheng-Qun Liu
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Su-Zhen Zhao
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Zhan-Wen Li
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Su-Ping Lv
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Yue-Qiang Liu
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Yi Li
- Experimental Medicine , Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
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Savran MM, Sørensen SMD, Konge L, Tolsgaard MG, Bjerrum F. Training and Assessment of Hysteroscopic Skills: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2016; 73:906-918. [PMID: 27209030 DOI: 10.1016/j.jsurg.2016.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/26/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this systematic review was to identify studies on hysteroscopic training and assessment. DESIGN PubMed, Excerpta Medica, the Cochrane Library, and Web of Science were searched in January 2015. Manual screening of references and citation tracking were also performed. Studies on hysteroscopic educational interventions were selected without restrictions on study design, populations, language, or publication year. A qualitative data synthesis including the setting, study participants, training model, training characteristics, hysteroscopic skills, assessment parameters, and study outcomes was performed by 2 authors working independently. Effect sizes were calculated when possible. Overall, 2 raters independently evaluated sources of validity evidence supporting the outcomes of the hysteroscopy assessment tools. RESULTS A total of 25 studies on hysteroscopy training were identified, of which 23 were performed in simulated settings. Overall, 10 studies used virtual-reality simulators and reported effect sizes for technical skills ranging from 0.31 to 2.65; 12 used inanimate models and reported effect sizes for technical skills ranging from 0.35 to 3.19. One study involved live animal models; 2 studies were performed in clinical settings. The validity evidence supporting the assessment tools used was low. Consensus between the 2 raters on the reported validity evidence was high (94%). CONCLUSIONS This systematic review demonstrated large variations in the effect of different tools for hysteroscopy training. The validity evidence supporting the assessment of hysteroscopic skills was limited.
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Affiliation(s)
- Mona Meral Savran
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Gynecology, University Hospital Nordsjaelland, Hillerod, Denmark
| | - Flemming Bjerrum
- Department of Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark
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Ablación-resección endometrial con resectoscopio monopolar: resultados. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Lo Monte G, Capobianco G, Piva I, Caserta D, Dessole S, Marci R. Hysterosalpingo contrast sonography (HyCoSy): let’s make the point! Arch Gynecol Obstet 2014; 291:19-30. [DOI: 10.1007/s00404-014-3465-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Benign smooth muscle tumours of the uterus, known as fibroids or myomas, are often symptomless. However, about one-third of women with fibroids will present with symptoms that are severe enough to warrant treatment. The standard treatment of symptomatic fibroids is hysterectomy (that is surgical removal of the uterus) for women who have completed childbearing, and myomectomy for women who desire future childbearing or simply want to preserve their uterus. Myomectomy, the surgical removal of myomas, can be associated with life-threatening bleeding. Excessive bleeding can necessitate emergency blood transfusion. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. This is an update of the review published in The Cochrane Library (2011, Issue 11). OBJECTIVES To assess the effectiveness, safety, tolerability and costs of interventions to reduce blood loss during myomectomy. SEARCH METHODS In June 2014, we conducted electronic searches in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsycINFO, and trial registers for ongoing and registered trials. SELECTION CRITERIA We selected randomised controlled trials (RCTs) that compared potential interventions to reduce blood loss during myomectomy to placebo or no treatment. DATA COLLECTION AND ANALYSIS The two authors independently selected RCTs for inclusion, assessed the risk of bias and extracted data from the included RCTs. The primary review outcomes were blood loss and need for blood transfusion. We expressed study results as mean differences (MD) for continuous data and odds ratios for dichotomous data, with 95% confidence intervals (CI). We assessed the quality of evidence using GRADE methods. MAIN RESULTS Eighteen RCTs with 1250 participants met our inclusion criteria. The studies were conducted in hospital settings in low, middle and high income countries.Blood lossWe found significant reductions in blood loss with the following interventions: vaginal misoprostol (2 RCTs, 89 women: MD -97.88 ml, 95% CI -125.52 to -70.24; I(2) = 43%; moderate-quality evidence); intramyometrial vasopressin (3 RCTs, 128 women: MD -245.87 ml, 95% CI -434.58 to -57.16; I(2) = 98%; moderate-quality evidence); intramyometrial bupivacaine plus epinephrine (1 RCT, 60 women: MD -68.60 ml, 95% CI -93.69 to -43.51; low-quality evidence); intravenous tranexamic acid (1 RCT, 100 women: MD -243 ml, 95% CI -460.02 to -25.98; low-quality evidence); gelatin-thrombin matrix (1 RCT, 50 women: MD -545.00 ml, 95% CI -593.26 to -496.74; low-quality evidence); intravenous ascorbic acid (1 RCT, 102 women: MD -411.46 ml, 95% CI -502.58 to -320.34; low-quality evidence); vaginal dinoprostone (1 RCT, 108 women: MD -131.60 ml, 95% CI -253.42 to -9.78; low-quality evidence); loop ligation of the myoma pseudocapsule (1 RCT, 70 women: MD -305.01 ml, 95% CI -354.83 to -255.19; low-quality evidence); and a fibrin sealant patch (1 RCT, 70 women: MD -26.50 ml, 95% CI -44.47 to -8.53; low-quality evidence). We found evidence of significant reductions in blood loss with a polyglactin suture (1 RCT, 28 women: MD -1870.0 ml, 95% CI -2547.16 to 1192.84) or a Foley catheter (1 RCT, 93 women: MD -240.70 ml, 95% CI -359.61 to -121.79) tied around the cervix. However, pooling data from these peri-cervical tourniquet RCTs revealed significant heterogeneity of the effects (2 RCTs, 121 women: MD (random) -1019.85 ml, 95% CI -2615.02 to 575.32; I(2) = 95%; low-quality evidence). There was no good evidence of an effect on blood loss with oxytocin, morcellation or clipping of the uterine artery.Need for blood transfusion We found significant reductions in the need for blood transfusion with vasopressin (2 RCTs, 90 women: OR 0.15, 95% CI 0.03 to 0.74; I(2) = 0%; moderate-quality evidence); peri-cervical tourniquet (2 RCTs, 121 women: OR 0.09, 95% CI 0.01 to 0.84; I(2) = 69%; low-quality evidence); gelatin-thrombin matrix (1 RCT, 100 women: OR 0.01, 95% CI 0.00 to 0.10; low-quality evidence) and dinoprostone (1 RCT, 108 women: OR 0.17, 95% CI 0.04 to 0.81; low-quality evidence), but no evidence of effect on the need for blood transfusion with misoprostol, oxytocin, tranexamic acid, ascorbic acid, loop ligation of the myoma pseudocapsule and a fibrin sealant patch.There were insufficient data on the adverse effects and costs of the different interventions. AUTHORS' CONCLUSIONS At present there is moderate-quality evidence that misoprostol may reduce bleeding during myomectomy, and low-quality evidence that bupivacaine plus epinephrine, tranexamic acid, gelatin-thrombin matrix, a peri-cervical tourniquet, ascorbic acid, dinoprostone, loop ligation and a fibrin sealant patch may reduce bleeding during myomectomy. There is no evidence that oxytocin, morcellation and temporary clipping of the uterine artery reduce blood loss. Further well designed studies are required to establish the effectiveness, safety and costs of different interventions for reducing blood loss during myomectomy.
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Affiliation(s)
| | - Charles Shey Wiysonge
- Stellenbosch UniversityCentre for Evidence‐based Health CareFrancie van Zijl DriveTygerbergCape TownSouth Africa7505
- South African Medical Research CouncilSouth African Cochrane CentreCape TownSouth Africa
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Dyrbye BA, Overdijk LE, van Kesteren PJ, de Haan P, Riezebos RK, Bakkum EA, Rademaker BM. Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial. Am J Obstet Gynecol 2012; 207:271.e1-6. [PMID: 22921098 DOI: 10.1016/j.ajog.2012.07.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/27/2012] [Accepted: 07/20/2012] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective of the study was to determine the incidence and amount of gas embolism during hysteroscopic surgery using either monopolar or bipolar diathermia and to investigate the relationship between the severity of gas embolism and the amount of intravasation of distension fluid. STUDY DESIGN This was a randomized, observer-blinded trial. Fifty patients, scheduled for hysteroscopic surgery, were assigned to either monopolar or bipolar diathermia. Transesophageal echocardiography was used to detect and classify gas embolism (grade 0-IV). Intravasation of distension fluid was measured. RESULTS Venous gas embolism was observed in all but 1 patient. A higher incidence of more extensive (grade IV) was seen during bipolar diathermia (42% vs 13%; P = .031). Paradoxical embolism was observed in 2 patients. When intravasation exceeded 1000 mL, significantly more grade IV venous gas embolism was seen (P = .049). CONCLUSION During hysteroscopic surgery, gas embolism was equally observed irrespective of the type of diathermia. However, more extensive embolism was observed when intravasation of distension fluid exceeded 1 L. These results question the acceptance of up to 2500 mL intravasation of distension fluid if bipolar diathermia is used.
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Kumar A, Kumar A. New Hysteroscopy Pump to Monitor Real-Time Rate of Fluid Intravasation. J Minim Invasive Gynecol 2012; 19:369-75. [DOI: 10.1016/j.jmig.2012.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/23/2012] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Uterine myomas (fibroids) are benign tumours of the uterus. Myomectomy, the surgical removal of myomas, can be associated with life-threatening bleeding and prolonged postoperative stay. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. This is an update of the review published in The Cochrane Library Issue 3, 2009. OBJECTIVES To assess the effectiveness, safety, tolerability, and costs of interventions to reduce blood loss during myomectomy. SEARCH STRATEGY Electronic searches were undertaken in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE (1950 to February 2011), EMBASE (1980 to February 2011), CINAHL (1982 to February 2011), and PsycINFO (1801 to February 2011). SELECTION CRITERIA Only randomised controlled trials (RCTs) that compared the use of interventions to reduce blood loss during myomectomy to placebo or no treatment were included. DATA COLLECTION AND ANALYSIS The two authors independently selected RCTs for inclusion, assessed the methodological quality of trials, and extracted data. We expressed study results as mean differences (MD) for continuous data and odds ratios for dichotomous data, with 95% confidence intervals (CI). MAIN RESULTS Twelve RCTs with 674 participants met our inclusion criteria. The interventions were intramyometrial vasopressin (two RCTs), intravenous oxytocin (two RCTs), peri-cervical tourniquet (two RCTs), and one RCT each for vaginal misoprostol, gelatin thrombin matrix, chemical dissection with sodium-2-mercaptoethane sulfonate (mesna), intramyometrial bupivacaine plus epinephrine, tranexamic acid, and myoma enucleation by morcellation. We found significant reductions in blood loss with misoprostol (MD -149.00 ml, 95% CI -229.24 to -68.76), vasopressin (MD -298.72 ml, 95% CI -593.10 to -4.34; I(2) = 99%), bupivacaine plus epinephrine (MD -68.60 ml, 95% CI -93.69 to - 43.51), tranexamic acid (MD -243 ml, 95% CI -460 to -25.98), peri-cervical tourniquet (MD -289.44, 95% CI -406.55 to -172.32; I(2) = 95%), and gelatin-thrombin matrix (MD -545.00 ml, 95% CI -593.26 to -496.74). There was no evidence of an effect on blood loss with oxytocin or morcellation. None of the interventions significantly increased myomectomy-related complications. The trials did not assess the costs of the different interventions. AUTHORS' CONCLUSIONS There is limited evidence that misoprostol, vasopressin, bupivacaine plus epinephrine, tranexamic acid, gelatin thrombin matrix, peri-cervical tourniquet, and mesna may reduce bleeding during myomectomy. Bupivacaine plus epinephrine has limited clinical importance compared with other interventions as the clinical impact was small. There is no evidence that oxytocin and morcellation reduce blood loss. Further well designed studies are required to establish effectiveness, safety and the costs of different interventions for reducing blood loss during myomectomy.
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Lok CA, Poynter CJ, Tait JD. Life-Threatening Complications of Operative Hysteroscopy: A Case Report and Review of the Literature. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christine A.R. Lok
- Department of Obstetrics and Gynaecology, Wellington Regional Hospital, Wellington, New Zealand
| | - Chris J. Poynter
- Department of Anaesthesia and Pain Management, Wellington Regional Hospital, Wellington, New Zealand
| | - John D. Tait
- Department of Obstetrics and Gynaecology, Wellington Regional Hospital, Wellington, New Zealand
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Rademaker B, van Kesteren P, de Haan P, Rademaker D, France C. How Safe Is the Intravasation Limit in Hysteroscopic Surgery? J Minim Invasive Gynecol 2011; 18:355-61. [DOI: 10.1016/j.jmig.2011.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/29/2010] [Accepted: 01/06/2011] [Indexed: 01/05/2023]
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Pathologic Characteristics of Hysterectomy Specimens in Women Undergoing Hysterectomy after Global Endometrial Ablation. J Minim Invasive Gynecol 2011; 18:96-9. [DOI: 10.1016/j.jmig.2010.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 10/04/2010] [Accepted: 10/07/2010] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Uterine myomas (fibroids) are benign tumours of the uterus. Myomectomy, the surgical removal of myomas, is an important treatment option especially for women who wish to preserve their uteri. The major problem with myomectomy is excessive bleeding, which can be life-threatening and prolong postoperative stay. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. OBJECTIVES To assess the effectiveness, safety, tolerability, and costs of interventions to reduce blood loss during myomectomy. SEARCH STRATEGY Electronic searches were undertaken in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to September 2008), EMBASE (1980 to September 2008), CINAHL (1982 to September 2008), and PsycINFO (up to September 2008). SELECTION CRITERIA Only randomised controlled trials (RCTs) that compared the use of interventions to reduce blood loss during myomectomy to placebo or no treatment were included. DATA COLLECTION AND ANALYSIS The two authors independently selected RCTs for inclusion, assessed the methodological quality of trials, and extracted data. We expressed study results as mean differences (MD) for continuous data and odds ratios for dichotomous data, with 95% confidence intervals (CI). MAIN RESULTS Ten RCTs with 531 participants met our inclusion criteria: intramyometrial vasopressin and analogues (two trials), intravenous oxytocin (two trials), and one RCT for each of the interventions vaginal misoprostol, peri-cervical tourniquet, chemical dissection with sodium-2-mercaptoethane sulfonate (mesna), intramyometrial bupivacaine plus epinephrine, tranexamic acid and the enucleation of myoma by morcellation while it is attached to the uterus. We found significant reductions in blood loss with misoprostol (MD -149.00 ml, 95% CI -229.24 to -68.76), vasopressin and analogues (MD -298.72 ml, 95% CI -593.10 to -4.34), bupivacaine plus epinephrine (MD -68.60 ml, 95% CI -93.69 to - 43.51), tranexamic acid (MD -243 ml, 95% CI -460 to -25.98), and peri-cervical tourniquet (MD -1870.00 ml, 95% CI -2547.16 to -1192.84). There was no evidence of effect on blood loss with myoma enucleation by morcellation or oxytocin. The trials did not assess the tolerability and costs of the different interventions. AUTHORS' CONCLUSIONS Evidence is limited from a few RCTs that misoprostol, vasopressin, bupivacaine plus epinephrine, tranexamic acid, tourniquet, and mesna may reduce bleeding during myomectomy. There is no evidence that oxytocin and morcellation have an effect on intraoperative blood loss. There is a need for adequately powered RCTs to shed more light on the effectiveness, safety, and costs of different interventions in reducing blood loss during myomectomy.
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Affiliation(s)
- Eugene J Kongnyuy
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK, L3 5QA
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Kim KO, Shin HI, Lee JH, Lee Y, Choi JG, Yoon DI. Pulmonary edema during hysteroscopic surgery: Three cases report. Korean J Anesthesiol 2009; 57:117-122. [PMID: 30625842 DOI: 10.4097/kjae.2009.57.1.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hysteroscopic surgery has become a routine gynecologic procedure. The advantages are associated with more accurate removal of lesion, its short operating time, rapid post-operative recovery and low morbidity. However, there are potentially serious complications which can be occured during and following hysteroscopic surgery. The complications are uterine perforation, fluid overload and electrolyte disturbance due to intravasation and absorption of uterine distention media, hemorrhage and, rarely, gas or air embolism. We experienced pulmonary edema during hysteroscopic surgery in three consecutive patients. Therefore, we report these cases of fluid overload with uterine distention media resulting acute pulmonary edema during hysteroscopic surgery.
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Affiliation(s)
- Kyoung Ok Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Hong Il Shin
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Jeoung Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Younsuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Jun Gwon Choi
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Dong Il Yoon
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
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Serocki G, Hanss R, Bauer M, Scholz J, Bein B. [The gynecological TURP syndrome. Severe hyponatremia and pulmonary edema during hysteroscopy]. Anaesthesist 2009; 58:30-4. [PMID: 18853124 DOI: 10.1007/s00101-008-1446-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fluid overload and dilutional hyponatremia are rare but typical complications of endoscopic transurethral resection of the prostate gland (TURP syndrome). Less commonly, this complication caused by excessive absorption of hypotonic, electrolyte-free non-conductive distention solution, may also occur during endoscopic surgery of the uterus, e.g. operative hysteroscopy. A case report is presented of a 44-year-old woman scheduled for operative hysteroscopy for intracavital myoma under general anaesthesia, suffering from severe absorption syndrome leading to hyponatremia of 106 mEq/l and pulmonary edema necessitating subsequent admission to ICU. Anatomical and physiological as well as technical aspects of this syndrome are discussed. Recommendations for anesthesiology management are offered and a possible treatment of acute hyponatremia is discussed.
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Affiliation(s)
- G Serocki
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein UKSH, Campus Kiel, Schwanenweg 21, 24105 Kiel, Deutschland.
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34
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Severe hyponatremia associated with transcervical resection of a uterine myoma. Can J Anaesth 2009; 56:316-9. [DOI: 10.1007/s12630-009-9054-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 01/09/2009] [Accepted: 01/15/2009] [Indexed: 10/20/2022] Open
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Young E, Sherrard-Jacob A, Knapp K, Craddock TS, Kemper C, Falvo R, Hunter S, Everson C, Giarrizzo-Wilson S. Perioperative Fluid Management. AORN J 2009. [DOI: 10.1016/j.aorn.2008.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hsieh MH, Chen TL, Lin YH, Chang CC, Lin CS, Lee YW. Acute pulmonary edema from unrecognized high irrigation pressure in hysteroscopy: a report of two cases. J Clin Anesth 2008; 20:614-7. [DOI: 10.1016/j.jclinane.2008.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 05/23/2008] [Accepted: 05/29/2008] [Indexed: 11/30/2022]
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Indications and options for endometrial ablation. Fertil Steril 2008; 90:S236-40. [DOI: 10.1016/j.fertnstert.2008.08.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 09/05/2006] [Accepted: 09/05/2006] [Indexed: 11/27/2022]
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Abstract
Complications during gynecologic surgery result from the proximity of the uterus and ovaries to other critical pelvic structures. These structures include the urinary tract, bowel, nerves, and vasculature. Knowledge of pelvic anatomy is important when performing these procedures and is critical in cases of altered anatomy from adhesive disease and during intraoperative hemorrhage. Recognition and repair of an unintended injury gives the best chance for minimizing sequelae from these complications.
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Affiliation(s)
- Michael P Stany
- Division of Gynecologic Oncology, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307, USA
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Della Badia C, Nyirjesy P, Atogho A. Endometrial ablation devices: Review of a manufacturer and user facility device experience database. J Minim Invasive Gynecol 2007; 14:436-41. [PMID: 17630160 DOI: 10.1016/j.jmig.2007.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 05/12/2007] [Accepted: 05/18/2007] [Indexed: 10/23/2022]
Abstract
Our objective was to evaluate complications reported to the Manufacturer and User Facility Device Experience (MAUDE) database and to look for trends of complications among various endometrial ablation devices. This database was not intended to be used either to evaluate rates of adverse events or to compare adverse event occurrence rates across devices. We performed a retrospective review of the Food and Drug Administration's MAUDE database. The database was queried for adverse events associated with the use of endometrial ablation devices. The following data were collected: event number, date reported, date of occurrence, type of ablation device, type of complication, adherence to manufacturer's protocol, brief description, disposition, who reported incident, report source, and cause of problem. The total number of adverse events reported in the United States for the time period January 1, 2003, through December 31, 2006, was 254. The largest number of major complications for cryoablation was bowel injury (n = 5), for microwave was bowel injury (n = 6), for hot water balloon was complications leading to hysterectomy (n = 7), for free circulating hot water was severe burns (n = 22), and for bipolar mesh was bowel injury (n = 19). The MAUDE database is useful to both the physician and manufacturer to look at trends and types of complications.
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Affiliation(s)
- Carl Della Badia
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania USA.
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Abstract
BACKGROUND Uterine myomas (fibroids) are benign tumours of the uterus. Myomectomy, the surgical removal of the myomas, is an important treatment option especially for women who desire to preserve their uteri. The major problem with myomectomy is excessive bleeding from increased uterine blood supply, and this can be life-threatening and prolong postoperative stay. Knowledge of the effectiveness of the interventions used to reduce blood loss during myomectomy is essential to enable evidence-based clinical decisions. OBJECTIVES To assess the effectiveness and safety of interventions (other than GnRH analogues) to reduce blood loss during myomectomy. SEARCH STRATEGY Electronic searches were undertaken in the Cochrane Menstrual Disorders and Subfertility Group specialised register, CENTRAL (Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), Current Contents (1993 to March 2006), the National Research Register, and the National Library of Medicine's Clinical Trial Register (up to March 2006). SELECTION CRITERIA Only randomised controlled trials (RCTs) that compared interventions to reduce blood loss during myomectomy to placebo or no treatment were included. DATA COLLECTION AND ANALYSIS The two authors independently selected RCTs for inclusion, assessed the methodological quality and extracted data. We expressed study results as weighted mean differences (WMD) for continuous data, and odds ratios for dichotomous data. MAIN RESULTS Eight RCTs met the inclusion criteria: two on intramyometrial vasopressin and analogues, and one each on vaginal misoprostol, IV oxytocin, pericervical tourniquet, chemical dissection with mesna, intramyometrial bupivacaine plus epinephrine and the enucleation of myoma by morcellation while it is attached to the uterus. We found significant reductions in blood loss with misoprostol (WMD -149.00 ml, 95% confidence interval [CI] -229.24 to -68.76), vasopressin and analogues (WMD -298.72 ml, 95% CI -593.10 to -4.34), bupivacaine plus epinephrine (WMD -68.60 ml, 95% CI -93.69 to - 43.51), and pericervical tourniquet (WMD -1870.00 ml, 95% CI -2547.16 to -1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin. The trials did not assess the tolerability and costs of different interventions. AUTHORS' CONCLUSIONS There is limited evidence from a few RCTs that misoprostol, vasopressin, bupivacaine plus epinephrine, tourniquet and mesna may reduce bleeding during myomectomy. There is no evidence that oxytocin and morcellation have an effect on intraoperative blood loss. There is need for adequately powered RCTs to shed more light on the effectiveness, safety and costs of different interventions in reducing blood loss during myomectomy.
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Affiliation(s)
- E J Kongnyuy
- University of Yaounde 1,PO Box 1364, Yaounde, Cameroon.
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Indications and options for endometrial ablation. Fertil Steril 2006; 86:S6-10. [PMID: 17055848 DOI: 10.1016/j.fertnstert.2006.07.1480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 09/05/2006] [Accepted: 09/05/2006] [Indexed: 11/23/2022]
Abstract
Endometrial ablation is an effective therapeutic option for the management of menorrhagia in properly selected patients. Hysteroscopic and non-hysteroscopic techniques offer similar rates of symptom relief and patient satisfaction.
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Abstract
Abnormal uterine bleeding is an important clinical concern and accounts for much medical intervention. This article presents an ultrasound-based approach to help exclude endometrial carcinoma and identify the source of bleeding for better clinical management. Saline infusion sonohysterography can help to triage patients to (1) no anatomic pathology, (2) globally thickened anatomic pathology that may be evaluated with blind endometrial sampling, or (3) focal abnormalities that must be evaluated under direct vision.
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Affiliation(s)
- Steven R Goldstein
- New York University School of Medicine, 530 First Avenue, Suite 10N, New York, NY 10016, USA.
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Abstract
Diagnostic and operative hysteroscopic procedures are performed to evaluate women with abnormal uterine bleeding structural uterine anomalies. Diagnostic and minimally invasive hysteroscopic surgical procedures in the hands of well-trained, experienced hysteroscopists offer little chance of serious complications. More extensive procedures offer greater risks, with fluid overload being the most common. The well-prepared and experienced hysteroscopic surgeon should have the ability, equipment, ancillary personnel, and facilities to prevent and to treat this problem, as well as the knowledge necessary to handle mechanical accidents, anesthetic complications, and post-procedure infections. The greatest risk in this procedure is, as always, an inadequately trained or ill-prepared operator.
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Hurskainen R. Managing drug-resistant essential menorrhagia without hysterectomy. Best Pract Res Clin Obstet Gynaecol 2006; 20:681-94. [PMID: 16731045 DOI: 10.1016/j.bpobgyn.2006.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Menorrhagia is a common disorder that requires plenty of resources. Rapid developments in medical technology have resulted in new management strategies, which are true alternatives to hysterectomy. In many countries the levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial destruction techniques are available for menorrhagia. Clinicians must answer questions about cost, effectiveness and quality of medical care when choosing the treatment option. This review integrates the results from the latest studies and review articles about LNG-IUS and endometrial destruction techniques by addressing the key clinical issues in menorrhagia. Both LNG-IUS and endometrial ablation seem to be good and effective alternative options to hysterectomy. Although these treatments have relatively high failure rates, the majority of women are satisfied and the cost-effectiveness of these treatments are better than that of hysterectomy. Both treatments have their advantages and disadvantages. Thus far LNG-IUS seems to be more cost-effective than endometrial resection or hysterectomy at 5 years follow-up. However, second generation ablation techniques may offer better cost-effectiveness than the first generation techniques, but the evidence is insufficient.
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Affiliation(s)
- Ritva Hurskainen
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hospital District of Helsinki and Uusimaa, Sairaalank 1, 05850 Hyvinkää, Finland.
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David A, Triolo O, Arena A, Palmara V, Floridia D, Mazzeo G, Mondello E, Trimarchi G, De Vivo A, Sinardi AU. Bioelectrical Impedance Monitoring in the Prevention of Intravasation Syndrome During Operative Hysteroscopy. J Gynecol Surg 2006. [DOI: 10.1089/gyn.2006.22.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio David
- Department of Neurosciences, Psychiatric and Anaesthesiologic Sciences Section of Anaesthesiology; University of Messina, Messina, Italy
| | - Onofrio Triolo
- Department of Gynaecological, Obstetrical Sciences, and Reproductive Medicine, University of Messina, Messina, Italy
| | - Alessandra Arena
- Department of Neurosciences, Psychiatric and Anaesthesiologic Sciences Section of Anaesthesiology; University of Messina, Messina, Italy
| | - Vittorio Palmara
- Department of Gynaecological, Obstetrical Sciences, and Reproductive Medicine, University of Messina, Messina, Italy
| | - Daniela Floridia
- Department of Neurosciences, Psychiatric and Anaesthesiologic Sciences Section of Anaesthesiology; University of Messina, Messina, Italy
| | - Giuliana Mazzeo
- Department of Neurosciences, Psychiatric and Anaesthesiologic Sciences Section of Anaesthesiology; University of Messina, Messina, Italy
| | - Epifanio Mondello
- Department of Neurosciences, Psychiatric and Anaesthesiologic Sciences Section of Anaesthesiology; University of Messina, Messina, Italy
| | | | - Antonio De Vivo
- Department of Gynaecological, Obstetrical Sciences, and Reproductive Medicine, University of Messina, Messina, Italy
| | - Angelo Ugo Sinardi
- Department of Neurosciences, Psychiatric and Anaesthesiologic Sciences Section of Anaesthesiology; University of Messina, Messina, Italy
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Takeda A, Manabe S, Hosono S, Nakamura H, Kato K, Koyama K. Successful treatment of submucosal myoma with acute severe uterine hemorrhage by emergency uterine arterial embolization followed by early hysteroscopic myomectomy: a report of two cases. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10397-005-0121-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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47
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Camuzcuoglu H, Yildirim Y, Sadik S, Kurt S, Tinar S. Comparison of the accuracy of hysteroscopy and hysterosalpingography in evaluation of the uterine cavity in patients with recurrent pregnancy loss. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10397-005-0114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Paschopoulos M, Kaponis A, Makrydimas G, Zikopoulos K, Alamanos Y, O'Donovan P, Paraskevaidis E. Selecting distending medium for out-patient hysteroscopy. Does it really matter? Hum Reprod 2004; 19:2619-25. [PMID: 15459167 DOI: 10.1093/humrep/deh464] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this prospective randomized study was to evaluate the role of carbon dioxide (CO2) and normal saline for diagnostic accuracy in out-patient hysteroscopy. METHODS Women admitted to our Department in order to undergo total abdominal hysterectomy also underwent diagnostic hysteroscopy, 12-24 h prior to surgery. The selection of distending medium was made after randomization. Two groups of patients were formed, group A (CO2; n=39) and group B (normal saline; n=35). More than half of the women in the study population were post-menopausal. Post-hysteroscopy, all women were asked to rank any symptom that they felt during the procedure on a 4-point scale (0=none; 1=mild; 2=severe; 3=inability to perform hysteroscopy). The hysteroscopic diagnosis was compared with the macroscopic findings and the histological examination of the surgical specimen after hysterectomy. RESULTS The percentage who completed hysteroscopy was 89.74% within group A and 97.14% within group B. Most patients of both groups felt some pain of mild intensity. The diagnostic accuracy of hysteroscopy was similar for both media when major pathology [large polyps (group A 91.7%; group B 92.7%), myomas (group A 81.25%; group B 92.7%) and/or hyperplasia (group A 87.5%; group B 90.2%)] of the endometrial cavity was detected. In contrast, in cases of minor pathology (small polyps, mucosal elevations, crypts, hypervascularization), hysteroscopy with saline presented with significantly higher diagnostic accuracy (85.4%) compared with hysteroscopy with CO2 (64.6%). CONCLUSIONS In out-patient hysteroscopy, CO2 and normal saline were comparable with regard to patient discomfort and for the detection of major pathology of the endometrial cavity. Normal saline seems to be the most appropriate medium for the detection of minor pathology of the endometrial cavity.
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Affiliation(s)
- M Paschopoulos
- Department of Obstetrics and Gynecology, Ioannina University School of Medicine, 45500 Ioannina, Greece
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Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Battista Nardelli G. Side effects and complications of sonohysterosalpingography. Fertil Steril 2003; 80:620-4. [PMID: 12969709 DOI: 10.1016/s0015-0282(03)00791-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the side effects and complications of, difficulties with, and possible solutions to the problems associated with sonohysterosalpingography. DESIGN Prospective study. SETTING University hospital. PATIENT(S) One thousand, one hundred fifty-three patients who underwent sonohysterosalpingography to investigate abnormal uterine bleeding, infertility, thick endometrium at transvaginal ultrasonography, müllerian abnormalities, or the Asherman syndrome. MAIN OUTCOME MEASURE(S) Side effects and complications of and difficulties related to the procedure. Tolerance was assessed by using a pain-rating scale. RESULT(S) Ninety-three percent (1,074 of 1,153) procedures were performed correctly. Investigation was not completed in 79 (7%) women; a second attempt was successful in 60 of these patients. Side effects, such as moderate or severe pelvic pain, vasovagal symptoms, nausea, and vomiting, occurred in 102 (8.8%) women. Such complications as fever and peritonitis occurred in 0.95% of patients. CONCLUSION(S) Sonohysterosalpingography is a simple, safe, and well-tolerated technique that has a low rate of side effects and rare complications.
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Affiliation(s)
- Salvatore Dessole
- Department of Pharmacology, Gynecology and Obstetrics, University of Sassari, Sassari, Italy.
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Imasogie N, Crago R, Leyland NA, Chung F. Probable gas embolism during operative hysteroscopy caused by products of combustion. Can J Anaesth 2002; 49:1044-7. [PMID: 12477675 DOI: 10.1007/bf03017899] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Gas embolism is a rare but well documented entity during operative hysteroscopy, with an incidence of 10-50%. Catastrophic outcomes occur at a rate of three in 17,000 procedures. The purpose of this report is to present a non-fatal case of gas embolism probably caused by the gaseous products of combustion. CLINICAL FEATURES A 50-yr-old woman with a history of menorrhagia was scheduled for hysteroscopy and endometrial ablation and polypectomy. Fifteen minutes into the procedure, with the patient in lithotomy position, 20 degree head down tilt, and breathing spontaneously, a sudden oxygen desaturation occurred from 97% to 87%. The patient's end-tidal carbon dioxide dropped from 46 mmHg to 27 mmHg. The patient's breathing pattern remained normal, respiratory rate remained 11-12 breaths x min(-1) but amplitude of the reservoir bag movement was increased. Cardiovascular variables remained stable. She responded rapidly to 100% oxygen and made an uneventful recovery. Having ruled out other possible causes, we concluded gas embolism was responsible for the fall in oxygen saturation and end-tidal CO(2). CONCLUSION With all the precautions in place to minimize the likelihood of fluid overload and ambient air embolism occurring, we surmised that products of combustion were the cause of the gas embolism. During endometrial ablation, gaseous products of combustion, mainly carbon dioxide, accumulate. The gases may then contribute to the rise in uterine pressure that occurs as irrigation fluid enters the uterus and this rise in pressure in turn encourages passage of gas into the open venous sinuses.
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Affiliation(s)
- Ngozi Imasogie
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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