Complications of hysteroscopic surgery: “Beyond the learning curve”

Abstract 

Study objective

To investigate the actual complication rate of hysteroscopic surgery performed by experienced endoscopic surgeons in a single medical center.

Design

A prospective descriptive study (Canadian Task Force classification III).

Setting

An endoscopic gynecology unit at a tertiary care university hospital.

Patients

Women from 21 to 82 (median 45.0) years, undergoing operative hysteroscopy for uterine disease.

Intervention

Operative hysteroscopy with glycine or saline solution used as an irrigation medium.

Measurements and main results

Data of short-term complications were prospectively collected during surgery and at the 2-week follow-up visit. Six hundred procedures were investigated. The total complication rate was 3%, with 1% of uterine perforations. Two-thirds of the complications were related to cervical dilation or uterine entry, and infertility was found to be a risk factor.

Conclusions

Hysteroscopic surgery, performed by a well-trained hysteroscopic surgeon, is a safe procedure with an overall complication rate of 3%. Most complications are related to cervical dilation or uterine entry techniques. Efforts therefore should be focused on identifying the patients at risk and finding novel techniques for cervical priming.

Keywords: Complications, Operative hysteroscopy, Surgeon’s experience, Uterine entry