Outcomes of surgical hysteroscopy: 25 years of observational study

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 Statement

• What 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.

Keywords:

• Intraoperative complications
• monopolar resectoscope
• operative hysteroscopy

Acknowledgments

The authors would like to express our sincere gratitude to the whole obstetrics and gynaecology department, especially the hysteroscopy unit at Parc Taulí University Hospital in Sabadell and to all the nurses from the outpatient surgery unit for monitoring and taking care of our patients.

Statement of prior presentation

One of the three best oral communications, presented in the opening ceremony of the Global Congress on Hysteroscopy, Barcelona, 1–3 May 2019.

Disclosure statement

The authors report no conflicts of interest.