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Zhang S, Di W, Wang Y, Shi J, Yin X, Zhang Y, Zhao A, Campo R, Bigatti G. Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate. Facts Views Vis Obgyn 2023; 15:53-59. [PMID: 37010335 PMCID: PMC10392109 DOI: 10.52054/fvvo.15.1.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Myoma removal remains a challenge hysteroscopically including for the “IBS®” Intrauterine Bigatti Shaver technique.
Objective: To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology.
Materials and methods: This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions.
Main outcome measures: Complete resection rates, total operation time, resection time and used fluid volume.
Results: Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003).
Conclusion: For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time.
What is new? Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.
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Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature. Case Rep Nephrol 2021; 2021:7195660. [PMID: 34594582 PMCID: PMC8478601 DOI: 10.1155/2021/7195660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hysteroscopic surgery is a minimally invasive procedure used to diagnose and treat intrauterine pathologies. It requires distension of the uterine cavity for the adequate visualization of the operative field. Glycine (1.5%) is one of the most commonly used solutions because it is nonconductive and also has good optical properties. However, acute hyponatremia is a critical complication that can develop after the absorption of a sufficient amount of the irrigation medium. Case Presentation. We report a case of a 43-year-old female patient who developed acute symptomatic hyponatremia (104 mEq/L) and pulmonary edema secondary to hysteroscopic resection of leiomyoma and hastily approached with rapid sodium correction measures. Conclusion Multiple strategies can be taken to reduce the risk of fluid absorption and subsequent hyponatremia. Moreover, attention should be paid to the treatment approach for patients with acute hyponatremia following hysteroscopic procedures; rapid correction of acute hyponatremia for such patients might be safe, although there is no consensus in the literature, and further trials are needed.
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Donan PC, Pace KA, Ruiz CW, Gracia MM. Distending Media Used During Hysteroscopy: Perioperative Nursing Implications. AORN J 2021; 112:634-648. [PMID: 33252805 DOI: 10.1002/aorn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hysteroscopy is a gynecological procedure that may be indicated for abnormal uterine bleeding, diagnosis and management of infertility, contraception, or sterilization. Surgeons use distending media during hysteroscopy to view the uterine cavity. Media options include carbon dioxide gas and both electrolytic and nonelectrolytic fluids. All distending media is absorbed by the patient's body, but the manner in which each media is absorbed is unique to its chemical composition. Understanding the properties of each distending medium and the risks involved with its use is critical to safe perioperative nursing care for patients undergoing hysteroscopy. This article provides perioperative nurses with a review of uterine anatomy and evidence-based information on the types of distending media used during hysteroscopy and the corresponding perioperative nursing implications.
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Okazaki H, Miura N, Kashima Y, Miyashita R, Oe K, Kawakami K, Ishikawa T, Masui K. Severe hyponatremia with seizures and confirmed mild brain edema by hysteroscopic myomectomy: a case report. JA Clin Rep 2020; 6:74. [PMID: 33001333 PMCID: PMC7530158 DOI: 10.1186/s40981-020-00381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyponatremia can be developed during hysteroscopic surgery with electrolyte-free irrigation fluid. We experienced severe hyponatremia with postoperative seizures and confirmed mild brain edema. CASE PRESENTATION A quadragenarian female patient underwent a 2-h hysteroscopic myomectomy with electrolyte-free fluid for uterine distension under general anesthesia. Plasma sodium level of 84.1 mmol/L 100 min after the start of surgery indicated excessive absorption of the irrigation fluid. Acute severe hyponatremia was diagnosed with significant edema in the conjunctiva, lip, and extremities. She was treated with a continuous infusion of hypertonic saline. However, seizures and cerebral edema developed 7 h later. The patient recovered without neurological deficits at postoperative day 2. CONCLUSION The electrolyte-free irrigation fluid can be absorbed rapidly during hysteroscopic surgery. Its interruption with hyponatremia should be considered against prolonged surgery. Especially under general anesthesia, caution should be exercised because the typical symptoms of hyponatremia such as nausea and confusion are blinded.
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Affiliation(s)
- Haruko Okazaki
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Norikazu Miura
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Yuki Kashima
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Ryoichi Miyashita
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Katsunori Oe
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Keiko Kawakami
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Tetsuya Ishikawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Kenichi Masui
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
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Gao PF, Lin JY, Wang S, Zhang YF, Wang GQ, Xu Q, Guo X. Antinociceptive effects of magnesium sulfate for monitored anesthesia care during hysteroscopy: a randomized controlled study. BMC Anesthesiol 2020; 20:240. [PMID: 32957926 PMCID: PMC7504853 DOI: 10.1186/s12871-020-01158-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
Background Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy. Methods Seventy patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 h, and 4 h after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered. Results Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P = 0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P = 0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75–150) vs 145 (75–175) μg, median (range); P < 0.001]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 h, and 4 h postoperatively. Conclusions In hysteroscopy, adjuvant magnesium administration is beneficial to reduce intraoperative fentanyl requirement and postoperative pain without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary. Trial registration ChiCTR1900024596. date of registration: July 18th 2019.
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Affiliation(s)
- Peng-Fei Gao
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Jing-Yan Lin
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China. .,Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China.
| | - Shun Wang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Yun-Feng Zhang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Guo-Qiang Wang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Qi Xu
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Xiao Guo
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
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Silva Santos AM, Coelho D. Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology's TURP Syndrome-A Case Report. Anesth Pain Med 2019; 9:e90285. [PMID: 31497521 PMCID: PMC6712280 DOI: 10.5812/aapm.90285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Operative hysteroscopy intravascular absorption (OHIA) syndrome is caused by intravascular absorption of fluid distension/irrigation medium during hysteroscopy. There are very few reported cases of this syndrome using saline as irrigation fluid. The current report was on a case of severe OHIA syndrome that necessitated resuscitation in an intensive care unit (ICU). Case Presentation A 41-year-old, 65-kg, smoker female patient was admitted for an endoscopic resection of submucous uterine myoma under general anesthesia using a laryngeal mask airway. In the 50th minute of the procedure, end-tidal CO2 dropped from 35 to 25 mmHg and pulse oximetry (SpO2) from 100% to 90%. Crackling sounds were heard from the base of the lungs. As a pulmonary oedema was suspected, the volume of irrigated saline was checked. A total of 4000 of the total 9000 mL of the saline had been absorbed into intravascular compartment. She developed a severe metabolic acidosis (pH 7.09) with severe hypokalemia (K+ 2.3 mEq/L), hypocalcaemia (Ca2+ 0.76 mEq/L), anemia (hemoglobin 5.3 g/dL), and hypothermia (tympanic temperature 33°C), as well as a generalized oedema with pulmonary and airway oedema. Due to airway oedema, she could only be intubated with a 6.5-mm tracheal tube. Resuscitation in the ICU was required. Electrolyte disturbances were corrected and furosemide was administered. She had a full recovery after 24 hours and 48 hours later, she was discharged. Conclusions Absorption of the irrigation fluid can result in life-threatening fluid overload. Accurate fluid balancing and limiting the operation time may prevent such complications. Therefore, early diagnosis and treatment of this syndrome is emphasized.
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Affiliation(s)
- Ana Margarida Silva Santos
- Anaesthesiology Department, Matosinhos Local Health Unit, Matosinhos, Portugal
- Corresponding Author: Anesthesiology Trainee, Matosinhos Local Health Unit, Rua São Teotónio lote 18, 5, 3000-377, Coimbra, Portugal. Tel: +35-1918824261,
| | - Daniela Coelho
- Intensive Care and Emergency Department, Matosinhos Local Health Unit, Matosinhos, Portugal
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Abstract
Hysteroscopy is performed to view and treat pathology within the uterine cavity and endocervix. Diagnostic hysteroscopy allows visualization of the endocervical canal, endometrial cavity, and fallopian tube ostia. Operative hysteroscopy incorporates the use of mechanical, electrosurgical, or laser instruments to treat intracavitary pathology and perform hysteroscopic sterilization procedures. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. A preoperative consultation allows the patient and physician to discuss the hysteroscopic procedure, weigh its inherent risks and benefits, review the patient's medical history for any comorbid conditions, and exclude pregnancy. Known pregnancy, genital tract infections, and active herpetic infection are contraindications to hysteroscopy. The most common perioperative complications associated with operative hysteroscopy are hemorrhage, uterine perforation, and cervical laceration. The procedure is minimally invasive and can be used with a high degree of safety.
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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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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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Pramod A, Rajagopal S, Iyer VP, Murthy HS. Glycine induced acute transient postoperative visual loss. Indian J Anaesth 2015; 59:318-9. [PMID: 26019359 PMCID: PMC4445156 DOI: 10.4103/0019-5049.156890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anita Pramod
- Department of Anaesthesia, Manipal Hospital, Bengaluru, Karnataka, India
| | | | - V Padmanabha Iyer
- Department of Anaesthesia, Manipal Hospital, Bengaluru, Karnataka, India
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Proposal of a modified transcervical endometrial resection (TCER) technique for menorrhagia treatment. Feasibility, efficacy, and patients’ acceptability. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-014-0844-6] [Citation(s) in RCA: 7] [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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Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-013-0827-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Chen CH, Lee WL, Wang IT, Yen YK, Chiu LH, Tzeng CR, Liu WM. Hysteroscopic myomectomy using a two-micron continuous wave laser (RevoLix). Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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How quickly can acute symptomatic hyponatremia be corrected? Int Urol Nephrol 2012; 45:1805-8. [PMID: 23054312 DOI: 10.1007/s11255-012-0291-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
The systemic absorption of the flush liquid, including sorbitol, glycine or mannitol, can lead to complications, such as hyponatremia, volume overload and pulmonary or cerebral edema. Acute hyponatremia is defined as a reduction in the plasma sodium level in less than 48 h. Acute symptomatic hyponatremia should be corrected aggressively because it may cause irreversible neurological damage and death. Rapid correction of hyponatremia causes severe neurologic deficits, such as central pontine myelinolysis; thus, the optimal therapeutic approach has been debated. This article examined acute symptomatic hyponatremia in a patient undergoing transcervical myomectomy for a submucosal myoma. A thirty-seven-year-old patient was evaluated in obstetrics and gynecology clinic because of altered mental status and agitation. There was no history of chronic illness or drug use. It was discovered that during the operation, 12 L of the flush fluid, which contained 5 % mannitol, had been infused, but only 7 L of the flush fluid had been collected. On physical examination, the patient's general condition was moderate, her cooperation was limited, she was agitated, and her blood pressure was 120/70 mmHg. The sodium level was 99 mEq/L. Furosemid and 3 % NaCl solution were given. Her serum sodium returned to normal by increasing 39 mEq/L within 14 h. Her recovery was uneventful, and she was discharged 24 h after her serum sodium returned to normal. In conclusion, if there is a difference between the infused and collected volumes of the mannitol irrigant, severe hyponatremia may develop due to the flush fluid used during transcervical hysteroscopy and myomectomy. In these patients, acute symptomatic hyponatremia may be corrected as rapidly as the sodium level dropped.
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Woo YC, Kang H, Cha SM, Jung YH, Kim JY, Koo GH, Park SG, Baek CW. Severe intraoperative hyponatremia associated with the absorption of irrigation fluid during hysteroscopic myomectomy: a case report. J Clin Anesth 2012; 23:649-52. [PMID: 22137519 DOI: 10.1016/j.jclinane.2011.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 02/22/2011] [Accepted: 03/02/2011] [Indexed: 11/26/2022]
Abstract
A case of severe hyponatremia with accompanying pulmonary edema and cardiovascular instability during a hysteroscopic myomectomy with general anesthesia is presented. The patient's sodium value decreased to 87 mmol/L. She was managed with aggressive maneuvers, including an infusion of 3% hypertonic saline. The patient's serum sodium increased to 113 mmol/L at the end of the operation, and it was increased up to 138 mmol/L at 48 hours. The patient recovered completely without neurologic sequelae.
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Affiliation(s)
- Young Cheol Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, 156-755, Republic of Korea
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Bergeron ME, Ouellet P, Bujold E, Cote M, Rhéaume C, Lapointe D, Beaudet C, Lemyre M, Laberge P. The Impact of Anesthesia on Glycine Absorption in Operative Hysteroscopy. Anesth Analg 2011; 113:723-8. [DOI: 10.1213/ane.0b013e31822649d4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bigatti G, Ferrario C, Rosales M, Baglioni A, Bianchi S. IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscopy: a randomised comparative study. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-011-0701-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Affiliation(s)
- P Tarneja
- Professor and Head, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411 040
| | - V K Tarneja
- Professor and Head, Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune - 411 040
| | - B S Duggal
- Classified Specialist (Obstetrics and Gynaecology). Military Hospital, Shillong - 793 007
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Jo YY, Jeon HJ, Choi E, Choi YS. Extreme hyponatremia with moderate metabolic acidosis during hysteroscopic myomectomy -A case report-. Korean J Anesthesiol 2011; 60:440-3. [PMID: 21738849 PMCID: PMC3121093 DOI: 10.4097/kjae.2011.60.6.440] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/03/2011] [Accepted: 01/06/2011] [Indexed: 11/26/2022] Open
Abstract
Excess absorption of fluid distention media remains an unpredictable complication of operative hysteroscopy and may lead to lethal conditions. We report an extreme hyponatremia, caused by using an electrolyte-free 5 : 1 sorbitol/mannitol solution as distention/irrigation fluid for hysteroscopic myomectomy. A 34-year-old female developed severe pulmonary edema and extreme hyponatremia (83 mmol/L) during transcervical endoscopic myomectomy. A brain computed tomography showed mild brain swelling without pontine myelinolysis. The patient almost fully recovered in two days. Meticulous attention should be paid to intraoperative massive absorption of fluid distention media, even during a simple hysteroscopic procedure.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science Gil Medical Center, Incheon, Korea
| | - Hyun Joo Jeon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eunkyeong Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Seon Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Berg A, Sandvik L, Langebrekke A, Istre O. A randomized trial comparing monopolar electrodes using glycine 1.5% with two different types of bipolar electrodes (TCRis, Versapoint) using saline, in hysteroscopic surgery. Fertil Steril 2009; 91:1273-8. [DOI: 10.1016/j.fertnstert.2008.01.083] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 01/22/2008] [Accepted: 01/22/2008] [Indexed: 11/25/2022]
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Bergeron ME, Beaudet C, Bujold E, Rhéaume C, Ouellet P, Laberge P. Glycine absorption in operative hysteroscopy: the impact of anesthesia. Am J Obstet Gynecol 2009; 200:331.e1-5. [PMID: 19254593 DOI: 10.1016/j.ajog.2008.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 11/13/2008] [Accepted: 12/20/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of anesthesia on the absorption of glycine in operative hysteroscopy. STUDY DESIGN A retrospective cohort study was performed over 2 years. The absorption of glycine was compared among general anesthesia, local anesthesia with intravenous sedation, and spinal anesthesia. Multiple logistic regression analyses were performed. RESULTS In all, 282 operative hysteroscopies were reviewed. The median absorption was 145 mL (10th-90th centile: 0-963 mL) for general anesthesia, 35 mL (10th-90th centile: 0-389 mL) for local anesthesia, and 100 mL (10th-90th centile: 0-500 mL) for spinal anesthesia (P = .002). In comparison with general anesthesia, local anesthesia was associated with lower rate of absorption of 500-1000 mL (4.2% vs 13.4%) and of 1000-1500 mL (3.6% vs 9.8; P = .002). Laparoscopic tubal ligation performed during the procedure was also associated with higher glycine absorption (odds ratio, 3.63; 95% confidence interval, 1.12-11.84). CONCLUSIONS Local anesthesia with sedation is associated with significantly decreased glycine absorption and lower rate of absorption > 500 mL when compared with general anesthesia.
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Affiliation(s)
- Marie-Eve Bergeron
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Québec, Faculty of Medicine, Université Laval, Québec City, QC, Canada
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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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Litta P, Cosmi E, Saccardi C, Esposito C, Rui R, Ambrosini G. Outpatient operative polypectomy using a 5mm-hysteroscope without anaesthesia and/or analgesia: Advantages and limits. Eur J Obstet Gynecol Reprod Biol 2008; 139:210-4. [DOI: 10.1016/j.ejogrb.2007.11.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 08/31/2007] [Accepted: 11/20/2007] [Indexed: 11/25/2022]
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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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Abstract
Although described in antiquity, the real dawn of uterine surgery was in the mid-19th century when hysterectomy was occasionally performed vaginally, usually for cancer or prolapse. Then, as now, women experienced symptoms of bleeding and pain emanating from the uterus, and when severe and debilitating, brave surgeons and patients sometimes explored hysterectomy as an alternative. Abdominal hysterectomy mortality rates in the mid-1850s were extremely high, but reduced drastically in the early to mid-20th century. By the 1950s, total hysterectomy supplanted supracervical techniques, largely as a method for preventing carcinoma of the cervix. Surgical alternatives to hysterectomy started in the 1930s with abdominal myomectomy and the first publication of nonhysteroscopic endometrial ablation from Germany, but by the end of the 20th century, included a plethora of techniques including laparoscopic, hysteroscopic, and interventional radiologic approaches. The advent of early detection of, and even prevention of, preinvasive cervical neoplasia, has led to a reevaluation of the need for total hysterectomy in many patients. In the early years of the millennium, targeted leiomyoma therapy was under development with a range of energy sources including cryogenic and radiofrequency probes, as well as focused ultrasound, targeted and controlled by magnetic resonance imaging.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Kaiser Foundation Hospitals, Los Angeles Medical Center, Los Angeles, California 90027, USA.
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Olive DL, Lindheim SR, Pritts EA. Conservative Surgical Management of Uterine Myomas. Obstet Gynecol Clin North Am 2006; 33:115-24. [PMID: 16504810 DOI: 10.1016/j.ogc.2005.12.012] [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] [Indexed: 11/29/2022]
Abstract
Uterine fibroids are a major gynecologic problem in American women, and several alternatives have been developed. Conservative treatment, with the goal of treating the fibroid but retaining the uterus, is a frequent choice among women who require therapy during their early to middle reproductive years. A variety of conservative surgical approaches exist; each has advantages and disadvantages for the clinician and the patient. Some are well-established techniques, whereas others are still in the investigational stage. None has been evaluated adequately for its effects on future fertility. To this end, it is imperative that investigators continue to evaluate these surgical procedures so that the clinician can provide accurate and comprehensive information when faced with a patient who desires one or more of these approaches. Furthermore, it is critical for the practitioner to stay informed about these procedures so that patients can be given a full complement of options.
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Affiliation(s)
- David L Olive
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine, 600 Highland Avenue, Madison, WI 53792-6188, USA.
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29
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Peritonitis From Sorbitol Distending Medium After Hysteroscopy. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200311001-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The potential adverse effects resulting from absorption of irrigation fluids during endoscopic procedures are well documented. Glycine, which is commonly used as an irrigation solution, has an inhibitory effect both on the central nervous system and on the retinal cells. We report the case of a woman who developed transient blindness following hysteroscopic myomectomy in which glycine was used as the irrigation solution.
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Affiliation(s)
- A Karci
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University Medical School, Izmir, Turkey.
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Marwah V, Bhandari SK. Diagnostic and interventional microhysteroscopy with use of the coaxial bipolar electrode system. Fertil Steril 2003; 79:413-7. [PMID: 12568855 DOI: 10.1016/s0015-0282(02)04689-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy and safety as a diagnostic and interventional outpatient procedure of microhysteroscopy using the coaxial bipolar electrode system (Versascope, Versapoint Electrosurgical System; Gynecare Inc., Menlo Park, CA) with normal saline solution as an irrigation medium. DESIGN Analysis of 151 cases of diagnostic and interventional procedures. SETTING Urban tertiary care center and teaching hospital. PATIENT(S) One hundred fifty-one women of reproductive age. INTERVENTION(S) Apart from diagnostic procedures, operative procedures were carried out microhysteroscopically with the coaxial bipolar electrode system. RESULT(S) Of the 151 patients who underwent the procedures, 94 received diagnostic microhysteroscopies, and 11 underwent the procedure for synechiotomy, 18 for polypectomy, 3 for submucus myoma resections, 7 for tubal cannulations, 5 for incomplete septal resection, 5 for endometrial ablation, and 8 for complete septal resection out of which 1 was completed with a 27F resectoscope using a knife monopolar electrode. All the patients were discharged the same day as admission. CONCLUSION(S) Use of a microhysteroscope with the coaxial bipolar electrode system is an effective alternative for carrying out diagnostic as well as operative microhysteroscopies. Although the field of vision is limited, with experience nearly all the procedures of hysteroscopy can be carried out as outpatient procedures using normal saline as the irrigation medium, thus avoiding the complications of glycine.
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Affiliation(s)
- Vivek Marwah
- Consultant Gynecological Endoscopic Surgeon, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
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Mushambi MC, Williamson K. Anaesthetic considerations for hysteroscopic surgery. Best Pract Res Clin Anaesthesiol 2002; 16:35-52. [PMID: 12491542 DOI: 10.1053/bean.2002.0206] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of the hysteroscope in modern gynaecological practice continues to develop as a diagnostic and management tool for intrauterine disease. Operative hysteroscopy (OH) is now an accepted alternative to hysterectomy for women with menorrhagia. The advantages of OH are associated with its short operating time, rapid post-operative recovery and low morbidity. However, there are concerns about the potential serious complications which can occur during and following OH, and it is important that both surgeons and anaesthetists are aware of these--especially as many procedures take place as day-cases. Much has been written in the urological literature concerning complications of endoscopic surgery. Information gathered from patients with post-transurethral resection of the prostate (TURP) syndrome has been useful in the treatment of gynaecology patients. However, the techniques used in TURP are not entirely comparable to hysteroscopic surgery as the uterus has a very thick wall, which requires higher distension pressures. The main complications of OH are fluid overload, hyponatraemia, hypo-osmolality, haemorrhage, uterine perforation and, rarely, gas or air embolism. Fluid overload with hyponatraemia and hypo-osmolality occurs in up to 6% of cases and it can be fatal. Therefore, all possible measures should be taken to prevent it or to detect it and treat it early. There are no controlled studies comparing different anaesthetic techniques for OH. Regional anaesthesia may offer an advantage over general anaesthesia because it enables early detection of fluid overload. Great care should be taken when positioning the patient to prevent peripheral neuropathy.
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Affiliation(s)
- Mary C Mushambi
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
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Katz Y, Moscovici R, Prego G, Merzel Y, Kniznik D, Lev A. A death following hysteroscopic myomectomy. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1365-2508.2001.00454.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Developments in both instruments and techniques have led to an increasing popularity of endoscopic surgery during the last two decades. Even though there are numerous advantages to using endoscopic surgery, life threatening surgical and anesthetic complications still exist. Precautions must be taken to cope with the potential complications. Anesthetic technique must provide optimal surgical conditions and lead to early recovery of the patient. Monitorization must allow safety of the patient during these potentially hazardous procedures. Both the anesthesiologist and the surgeon must be thoroughly aware of the potential complications of the procedure. This review discusses the physiological alterations occurring during operative endoscopy, the principles of anesthetic management and complications related both to surgery and to anesthesia techniques.
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Affiliation(s)
- F Coşkun
- Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Golan A, Sagiv R, Berar M, Ginath S, Glezerman M. Bipolar electrical energy in physiologic solution--a revolution in operative hysteroscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2001; 8:252-8. [PMID: 11342733 DOI: 10.1016/s1074-3804(05)60586-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the feasibility and efficiency of operative hysteroscopy in physiologic saline solution. DESIGN Prospective observational study (Canadian Task Force classification II-2). SETTING Tertiary university hospital. PATIENTS One hundred sixteen women (56% menopausal) with intrauterine pathology with or without symptoms, in whom malignancy was excluded by endometrial sampling. INTERVENTION Operative hysteroscopy for resection of uterine septa, lysis of adhesions, and resection of myomas or polyps using a bipolar electrical energy system (VersaPoint) developed for this purpose. MEASUREMENTS AND MAIN RESULTS Polyps were significantly more common in menopausal than in premenopausal women. Symptoms (mainly bleeding) occurred in 66.9% of premenopausal and 74.5% of menopausal patients. Endometrial polyps and submucous myomata were associated with symptoms in 68% and 70%, respectively. Operating time was less than 25 minutes. Two specimens revealed malignancy. One uncomplicated uterine perforation occurred. CONCLUSION This new technique has the potential to replace monopolar-based intrauterine interventions and may become the treatment of choice for benign intrauterine pathology.
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Affiliation(s)
- A Golan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon 58100, Israel
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36
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Abstract
Hysteroscopy is becoming a more widely used technique. Diagnostic hysteroscopy is replacing conventional dilatation and curettage in the diagnosis of intrauterine pathologies. Transcervical endometrial resection is often the first-line surgical treatment for dysfunctional uterine bleeding and carries less associated morbidity and morality. Overall, the technique is extremely safe, but vigilance is required particularly for intravasation of irrigation media. Complications such as gas embolus and hypo-osmolar hyponatremia require prompt treatment to reduce associated morbidity and morality. Careful monitoring of fluid deficit is paramount in avoiding the latter problem. Regional or general anesthetic techniques can be used and, in the ambulatory or office-based setting, in which these procedures are increasingly performed, the need for "street readiness" can influence the choice of the agents used.
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Affiliation(s)
- J A Murdoch
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Eskandar MA, Vilos GA, Aletebi FA, Tummon IS. Hysteroscopic endometrial ablation is an effective alternative to hysterectomy in women with menorrhagia and large uteri. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2000; 7:339-45. [PMID: 10924627 DOI: 10.1016/s1074-3804(05)60476-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVES To examine the feasibility, safety, and outcome of hysteroscopic endometrial ablation, and to determine the volume of fluid absorbed during resection versus rollerball coagulation in women with menorrhagia and large uteri. DESIGN Retrospective review (Canadian Task Force classification II-2). SETTING University-affiliated teaching hospital. PATIENTS Forty-two consecutive patients (mean +/- SD age 45.6 +/- 6 yrs) with uterine size greater than 12 weeks (cavity >12 cm). Intervention. Endometrial ablation; 26 (62%) women were pretreated to thin the endometrium. MEASUREMENTS AND MAIN RESULTS Resection was performed in 27 patients (65%) and rollerball coagulation in 15 (35%). Ablation was successfully performed in all patients in a day surgery setting. Multiple regression analysis examined the relationship of uterine size, pretreatment, procedure, and duration of surgery to amount of glycine absorbed. Glycine absorption was higher with resection than with coagulation (p = 0.04). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.04) but not with duration of the procedure, uterine size, or pretreatment. One patient with uterine fibroids and one with endometrial adenocarcinoma had hysterectomy. With follow-up of 39 (95%) of 41 women (excluding the one with adenocarcinoma) for 14 +/- 2 months, 38 (93%) were very satisfied. Thirty (73%) had amenorrhea, six (15%) had hypomenorrhea (<3 pads/day), and three (7%) had eumenorrhea (<10 pads/day). CONCLUSION Hysteroscopic endometrial ablation may be a feasible, safe, and effective alternative to hysterectomy in women with menorrhagia and large uteri.
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Affiliation(s)
- M A Eskandar
- Department of Obstetrics and Gynecology, St. Joseph's Health Center, 268 Grosvenor Street, London, Ontario, Canada
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38
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Cooper JM, Brady RM. Intraoperative and early postoperative complications of operative hysteroscopy. Obstet Gynecol Clin North Am 2000; 27:347-66. [PMID: 10857125 DOI: 10.1016/s0889-8545(00)80026-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
With preoperative evaluation, meticulous technique, and vigilance for impending problems, intraoperative and early postoperative complications of operative hysteroscopy are largely preventable. Fluid overload is the most common serious complication. The hysteroscopist must understand the significant differences between hypotonic, electrolyte-free distention media and isotonic, electrolyte-containing media and their respective sequelae. As new operative tools become available, hypotonic and electrolyte-free distention media may become obsolete. The physiology and management of air embolism, the most grave intraoperative complication, are essential to the knowledge base of any active hysteroscopist. Mechanical accidents, anesthetic complications, laser and electrical injury, and infections can be reduced by knowledge and preparation. Technologic advances, ongoing research, and postgraduate training in hysteroscopic technique continue to expand the safe and beneficial applications of hysteroscopy into the next century.
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Affiliation(s)
- J M Cooper
- Department of Obstetrics and Gynecology, University of Arizona, School of Medicine, Phoenix Baptist Hospital, USA
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39
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Randomized Comparison of Vaporizing Electrode and Cutting Loop for Endometrial Ablation. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199910000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Römer T, Müller J. A simple method of coagulating endometrium in patients with therapy-resistant, recurring hypermenorrhea. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999; 6:265-8. [PMID: 10459024 DOI: 10.1016/s1074-3804(99)80058-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To assess the efficacy, safety, and tolerability of hydrothermablation in the treatment of recurrent menorrhagia. DESIGN Prospective, nonrandomized survey (Canadian Task Force classification II-2). SETTING Endoscopic center at a university hospital. PATIENTS Eighteen premenopausal women with recurring menorrhagia resistant to hormone treatment. INTERVENTIONS Coagulation of the endometrium at 90 degrees C for 10 minutes under hysteroscopic control. MEASUREMENTS AND MAIN RESULTS During follow-up of least 12 months, nine (50%) of patients had amenorrhea and 17 (94%) had reduction or cessation of pathologic blood flow. One woman underwent hysterectomy because of recurrent dysmenorrhea. CONCLUSION In this study, hydrothermablation was a safe and effective method of treating recurrent menorrhagia. It does not require extensive training and may help avoid hysterectomy. (J Am Assoc Gynecol Laparosc 6(3):265-268, 1999)
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Affiliation(s)
- T Römer
- Department of Obstetrics and Gynaecology Ernst-Mortiz-Arndt-University, Greifswald, Germany
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41
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Motashaw ND, Dave S. Vision disturbances after operative hysteroscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999; 6:213-5. [PMID: 10226136 DOI: 10.1016/s1074-3804(99)80106-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Vision disturbance after transurethral resection of the prostate using glycine (1.5% aminoacetic acid) as the irrigating fluid is well known (TURP syndrome). Not so commonly seen or reported is transient blindness after operative hysteroscopy with glycine. It occurred in a 38-year-old woman who underwent hysteroscopic myomectomy and endometrial resection in which the distention medium was glycine. (J Am Assoc Gynecol Laparosc 6(2):213-215, 1999)
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Affiliation(s)
- N D Motashaw
- "Delstar" 9/A, Patkar Marg, Godrej Chowk (Kemp's Corner), Mumbai 400 036, India
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42
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Abstract
Most of the complications of hysteroscopy are avoidable and, fortunately, rare. With improved training, experience, and technology, most of these complications should become extinct. There will always be some unavoidable complications as well as difficulties resulting from inexperience. A goal for the future is to teach operating room personnel how to recognize and treat these complications to ensure the best patient outcome possible. Once gynecologic surgeons recognize the safety and efficacy of diagnostic and operative hysteroscopy as a minimally invasive option to treat benign uterine pathology, these procedures will proliferate and result in better patient care and improved quality of life.
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Affiliation(s)
- K B Isaacson
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The ever-increasing value of diagnostic and operative hysteroscopy for patients with AUB serves as an appropriate, although belated, tribute to Pantaleoni who in 1869 dared to look inside a woman's uterus. Future generations of women and their physicians will be indebted to this physician-pioneer. Contemporary instrumentation permits the gynecologist to acquire quickly the basic skills necessary for routine performance of office-based hysteroscopy. With increasing experience, operative hysteroscopic techniques, including resection of polyps, myomata, and endometrial ablation, can be easily mastered.
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Affiliation(s)
- J M Cooper
- University of Arizona School of Medicine, Phoenix, USA
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Kriplani A, Nath J, Takkar D, Kaul HL. Biochemical hemodynamic and hematological changes during transcervical resection of the endometrium using 1.5% glycine as the irrigating solution. Eur J Obstet Gynecol Reprod Biol 1998; 80:99-104. [PMID: 9758269 DOI: 10.1016/s0301-2115(98)00101-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To study fluid absorption during transcervical resection of the endometrium (TCRE) and its effect on the biochemical, hemodynamic and hematological alterations so that life threatening complications of fluid overload may be prevented. METHOD Intraoperative fluid (1.5% glycine) absorption in 46 women undergoing TCRE was studied and correlated using biochemical parameters (serum sodium, potassium, total proteins, creatinine and blood urea), hemodynamic parameters (pulse rate, blood pressure, oxygen saturation and end tidal CO2) and hematological parameters. Twenty five of these patients had received danazol (800 mg/day) for six weeks prior to TCRE. RESULT The mean glycine deficit during TCRE was found to be 474.45 ml, with a mean total inflow of 3802.17 ml. Amongst all of the parameters, only serum sodium levels were found to be significantly inversely correlated with the glycine deficit. No case of hyponatremia occurred below a deficit of 1000 ml. Severe hyponatremia was reported in three cases (6.4%) and all three had a glycine deficit of more than 1000 ml. No case of pulmonary edema was noted. The mean glycine deficit was significantly lower (P=0.007) and the duration of procedure significantly shorter (P=0.0009) in the patients who had received danazol. None of the patients in the danazol group had fluid absorption of more than 1000 ml. CONCLUSION Close monitoring of fluid inflow and outflow should be done during TCRE. Above a deficit of 1000 ml, serum sodium should be measured to detect significant hyponatremia. The use of danazol for endometrial preparation also reduces the mean amount of fluid absorbed.
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Affiliation(s)
- A Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi
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Taskin O, Buhur A, Birincioglu M, Burak F, Atmaca R, Yilmaz I, Wheeler JM. Endometrial Na+, K+-ATPase pump function and vasopressin levels during hysteroscopic surgery in patients pretreated with GnRH agonist. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1998; 5:119-24. [PMID: 9564057 DOI: 10.1016/s1074-3804(98)80076-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endometrial Na+, K+-adenosine triphosphatase (ATPase) pump function and peripheral blood vasopressin levels, and their role in fluid absorption and mechanisms of hyponatremia in patients undergoing hysteroscopic endometrial ablation. DESIGN Prospective, randomized, placebo-controlled study (Canadian Task Force classification I). SETTING University-affiliated hospital. PATIENTS Seventeen women with dysfunctional uterine bleeding. INTERVENTION Nine women received a GnRH analog and eight received saline approximately 6 to 8 weeks before hysteroscopic ablation by electrosurgery. MEASUREMENTS AND MAIN RESULTS Both before randomization and immediately before surgery, endometrial biopsy samples were obtained and numbered consecutively without patient identification. Operative hysteroscopy was performed with glycine 1.5% mixed with 2% alcohol. The amount of irrigant and irrigant deficit; blood levels of albumin and ethanol; hematocrit and hemoglobin; changes in sodium levels; and central venous pressure were compared. The Na+, K+-ATPase pump activity was significantly increased in the GnRH analog group compared with the saline group and correlated with decreased estradiol levels (0.4 +/- 0.08 vs 0.26 +/- 0.06 micro mol/min/ml). Vasopressin levels were significantly lower in the GnRH group (3.2 +/- 0.9 vs 7.6 +/- 1.7 micro mol/L). Mean volume of irrigant used and operating time were similar in both groups. Volume deficit, decrease in protein, and hematocrit were less in GnRH than in the saline group. Blood ethanol levels, decrease in sodium, and irrigant deficit were significantly lower in GnRH group. CONCLUSION Pretreatment with GnRH analogs may prevent the adverse effects of estradiol on endometrial Na+, K+-ATPase and creates a protective mechanism against iatrogenic hyponatremia, which is more critical in women than men in case of absorption of irrigating fluid. Moreover, created hypoestrogenism may enhance Na+, K+-ATPase activity in brain as well as endometrium, thus decreasing women's susceptibility to hyponatremic complications and brain damage. Suppressed vasopressin levels may be protective against fluid absorption in GnRH analog-treated patients.
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Affiliation(s)
- O Taskin
- Department of Obstetrics and Gynecology, Inonu University Medical School, Malatya, Turkey
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46
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Abstract
Hysteroscopy is used as a diagnostic tool for intrauterine pathology. Gas embolism with air or carbon dioxide is a rare but sometimes fatal complication of laparoscopy or hysteroscopy. We present a patient who developed pulmonary air embolism during hysteroscopy that caused a noncardiogenic pulmonary edema in the recovery room. This case report emphasizes that early intervention can prevent life-threatening events associated with pulmonary embolism during hysteroscopy. Pathophysiology of pulmonary gas embolism, as well as that of noncardiogenic pulmonary edema, is discussed. A protocol for the prevention, early detection, and management of this emergency is provided.
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Affiliation(s)
- R Behnia
- Department of Anesthesia, Northwestern University Medical School, Chicago, IL 60611, USA
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47
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Moir CL, Mandin H, Brant R. Sorbitol 2.5% mannitol 0.54% irrigation solution for hysteroscopic endometrial ablation surgery. Can J Anaesth 1997; 44:473-8. [PMID: 9161739 DOI: 10.1007/bf03011933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine if systemic absorption of sorbitol 2.5%/mannitol 0.54% irrigation solution (165 mosm.L-1) during hysteroscopic endometrial ablation with diathermy is associated with hyponatraemia and hypoosmolality. METHODS In 35 day surgery patients in a university hospital we measured baseline preoperative variables: serum sodium and creatinine concentrations and osmolality, haematocrit, haemoglobin, urine osmolality and sodium concentration, and weight. Fractional excretion of sodium (FENa) was calculated. The same observations were obtained postoperatively before discharge (one hour post resection). Volumes of intraoperative fluid irrigation intravasation and perioperative intravenous fluid absorption (lactated Ringer's solution) were estimated clinically (volumetric). RESULTS The mean (+/-SD) serum sodium concentration preoperatively was 140.3 +/- 2.4 mmol.L-1; and postoperatively, 139.7 +/- 2.2 mmol.L-1 (P = NS). The serum osmolality decreased from 285.4 +/- 4.5 to 282.6 +/- 4.1 mmol.kg-1 (P < 0.001). The mean volume of intravasated irrigation fluid was 26.4 ml (range 0-300). During the same time, the FENa increased from 0.57% to 0.79% (P < 0.001). CONCLUSION In these patients, closely and continuously observed for imbalance between infused and collected irrigation fluid, these was no clinical evidence for hyponatraemic hypoosmolality. However, there was a small 1% +/- 1.5% (mean +/- SD; range -3.4 to 3.6%) decrease in plasma osmolality despite adequate blood volumes as shown by urinary sodium indices.
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Affiliation(s)
- C L Moir
- Department of Anesthesia, University of Calgary, AB.
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Ellingson TL, Aboulafia DM. Dextran syndrome. Acute hypotension, noncardiogenic pulmonary edema, anemia, and coagulopathy following hysteroscopic surgery using 32% dextran 70. Chest 1997; 111:513-8. [PMID: 9042009 DOI: 10.1378/chest.111.2.513] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Dextran solutions are favored distending media for many hysteroscopic procedures because they are easy to administer, distribute uniformly within the uterine cavity, and are relatively nontoxic. We present the case of a 26-year-old woman who developed hypotension, noncardiogenic pulmonary edema, and hemorrhagic diathesis following hysteroscopic surgery with 32% dextran 70. A medical literature review indicates that following hysteroscopic surgery in which dextran solution has been used, "dextran syndrome" has been diagnosed in some patients. This syndrome is characterized by acute hypotension, hypoxia, coagulopathy, and anemia. We speculate on the pathogenesis of this condition and offer recommendations on how to evaluate and treat this rare dextran-related complication.
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Affiliation(s)
- T L Ellingson
- Division of Internal Medicine, Evertt Clinic, Wash, USA
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Abstract
Hysteroscopic procedures, which are an alternative to hysterectomy for surgical treatment of menorrhagia and uterine fibroids, place women at risk for intravasation of uterine distention fluid. Intravasation can produce fluid overload, pulmonary edema, congestive heart failure, and electrolyte imbalances. To examine risk factors for and evaluate nursing interventions to decrease the incidence of intravasation, the researchers compared mean arterial pressures (MAPs) and intrauterine pressures (IUPs) in two groups of women undergoing elective outpatient hysteroscopic procedures. The experimental group consisted of 20 women in whom fluid infusion pump pressures were maintained below the women's MAPs. The control group consisted of 20 women whose fluid infusion pump pressures were set at random. Distention fluid deficits and the total infused distention fluid volume differed significantly between the two groups, supporting the study hypothesis that maintaining equilibrium between women's IUPs and MAPs decreases the risk of uterine distention fluid absorption into the vasculature and fluid overload complications. Perioperative nurses need to monitor women's MAPs before and during hysteroscopic procedures and maintain fluid infusion pump pressures at or below women's MAPs to decrease the potential for intravasation.
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Affiliation(s)
- K L Bennett
- University of Wisconsin Hospital and Clinics, Madison, USA
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Tomazevic T, Savnik L, Dintinjana M. An automated gravitational system for delivery of low-viscosity media during continuous-flow hysteroscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1996; 3:617-21. [PMID: 9050698 DOI: 10.1016/s1074-3804(05)80176-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We constructed an automated gravitational system to control fluid dynamics during hysteroscopic operations. The new system allows linear regulation of intrauterine pressure by varying the flow by simply changing the height of the fluid-filled bag above the patient. The outflow from the automated gravitational system is also driven by gravity. Between January 1994 and June 1995 we performed 88 hysteroscopic operations: 10 myomectomies, 8 endometrial ablations, 3 polypectomies, 3 lysis of synechiae, and 64 transcervical metroplasties. With the Vario Flow system we obtained good visualization, and all operations were performed adequately in one attempt. No surgical or general complications were encountered. We presume that patient safety will be increased further with the second version of this system, which has a built-in electronic fluid deficit-control system.
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Affiliation(s)
- T Tomazevic
- Department of Obstetrics and Gynecology, University Medical Center, Slajmerjeva 3, 1000 Ljubljana, Slovenia
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