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.