Abstract
Purpose
Hysteroscopy is one of the least invasive gynecologic endoscopic surgical methods. However, it is associated with specific complications including uterine perforation and water intoxication. This study retrospectively analyzed the results of hysteroscopic surgeries performed in a single facility to obtain useful data for reducing complications.
Methods
290 hysteroscopic surgical cases performed between 1996 and 2010 were divided by operative time (cut-off 120 minutes) and by difference between infusion and drainage volumes (cut-off 750ml). Pre- and post-operative difference in mean sodium concentration and incidence of water intoxication were compared between the groups. Other complications were also investigated. Water intoxication caused by hyponatremia is characterized by intraoperative symptoms, including tremor, hypothermia, hypoxemia, asphyxia, and mydriasis, and postoperative symptoms, including headache, hypotension, general malaise, muscle cramps/twitching, disturbed consciousness, nausea, and vomiting. We present an incidence of water intoxication defined as hyponatremia (< 130 mEq/L) characterized by these symptoms.
Results
Pre- and post-operative difference in mean sodium concentration was -0.3mEq/L for operative duration < 120 minutes and 10.2mEq/L for operative time > 120 minutes (p<0.01). Incidence of water intoxication was 0% for operative time < 120 minutes and 22.2% for operative time > 120 minutes (p<0.01). Pre- and post-operative difference in mean sodium concentration was 1.3mEq/L when infusion exceeded drainage by < 750 ml and 7.2 mEq/L when infusion exceeded drainage by > 750ml (p < 0.05). Incidence of water intoxication was 0.4% when infusion exceeded drainage by < 750ml and 6.8 % when infusion exceeded drainage by > 750ml (p<0.01). Overall complication rate was 2.1%, including 2 cases of uterine perforation and 4 cases of water intoxication.
Discussion
Recommended surgical conditions for hysteroscopy include operative duration of < 120 minutes and difference between infusion and drainage volumes of < 750ml to avoid water intoxication.
