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| Courtesy: Hysteroscopy newsletter |
A series of precautions taken during before, during and after the hysteroscopic surgery can considerably reduce the risk of complications — reports Dr. Alice Rhoton-Vlasak, MD, Division of Reproductive Endocrinology & Infertility, from the University of Florida in the recent Hysteroscopy newsletter.
Hysteroscopy has evolved from merely a diagnostic procedure to method of choice for surgical treatment of intrauterine pathologies. Pantoleoni performed the first hysteroscopy using Desormeaux hysteroscope in 1869, and since then the development of hysteroscopy has flourished.
With the increasing number of endometrial ablations, morcellation, electrosurgical procedures, and hysteroscopic sterilization performed worldwide, hysteroscopy has finally found its well-deserved niche in gynecological armamentarium.
It is generally a low-risk technique that utilizes the body’s natural passage to gain entry inside the uterine cavity. But like every surgical procedures complication are known to happen. These can be further reduced by taking simple precautions and being familiar with equipment and distention media.
Before the start of the procedure, the patient should be positioned appropriately to avoid nerve injury because the actual surgical time may be longer than the estimated time.
To avoid uterine perforation under challenging cases like Asherman’s syndrome or sizeable submucosal myoma, always use synchronous laparoscopic or ultrasound guidance.
The light source, suction and irrigation systems should be checked for smooth working before the start of the procedure. A backup set of instruments should be available in case of any intra-operative emergency.
Cervical dilatation should be cautiously performed, and precaution should be taken to avoid endometrial trauma and perforation. Hysteroscopic dilation of the cervix using the scope and hydrodistension is ideal.
Flushing air from tubes easily avoids air embolism, and it is always advisable to stop the procedure to purge the air out during the change of bags. The patient should not be put in Trendelenburg position during cervical dilatation and the hysteroscopic procedure to avoid a suction that may draw air into the uterine cavity.
Insert the hysteroscope cautiously inside the uterine cavity to avoid the formation of false passage in the cervix.
Hemorrhage during the hysteroscopic surgery is preventable with the use of electrosurgical coagulation, injection of vasopressin into the cervical stroma or the use of a Foley catheter balloon to exert intrauterine tamponade.
Avoid fluid overload by keeping a strict record of ins and out, limiting excess fluid absorption, and use of isotonic solutions in healthy individuals. Special precautions should be taken in older patients and those with heart failure or renal insufficiency.
A preoperative pelvic examination before the start of procedure gives a good idea of the uterine position. If the hysteroscope is in and the uterus fails to distend any time— a possibility of uterine perforation should be kept in mind. Stop the procedure immediately, and laparoscopy may be needed to assess the damage.
If any of the new morcellators or electrosurgical devices are introduced during a procedure, the entire surgical team should be aware of their functioning.
Following this simple safety tips can reduce the rate of hysteroscopic complications considerably. Besides, the patient should be made aware of all the risks before scheduling the procedure, and informed consent should be obtained.
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