Complications in Hysteroscopy

  • Bruno J. van HerendaelEmail author


Hysteroscopic surgery in general has a low risk of adverse events with an incidence of around 0.28% of 13,600 procedures according to a large Dutch multicentre study [1]. A similar incidence of 0.24% was found in a German observational study that included 21,676 procedures [2]. It is clear that the risk of complications is increased in more complex operative procedures; e.g. in hysteroscopic myomectomy the risk might be as high as 10% [3]. Complications of hysteroscopic surgery may be due to patient positioning, anaesthesia, access problems, use of distending media, gas emboli, perforation of the uterine wall, bleeding, use of instruments, or infection, or may be caused by the formation of intrauterine adhesions (IUAs), dissemination of endometrial cancer cells, or unwanted pregnancy [4]. Randomized controlled trials (RCTs) on the effectiveness of strategies to prevent complications do exist. A large body of the presented evidence on complications due to hysteroscopic surgery is based on observational studies.


Hysteroscopic surgery Complications Incidence Distension media Gas media Liquid media Instruments Dissemination 

Supplementary material (60 kb)
Image 23.1 Perforated left Essure recognised during laparoscopic removal (JPG 50 kb) (53 kb)
Image 23.2 Perforated right Essure recognised 3 months after placement by curled presentation (JPG 44 kb) (153 kb)
Image 23.3 Chicken wing configuration left Essure recognised during laparoscopic removal (JPG 155 kb) (16 kb)
Image 23.4 Double perforation both Essure devices recognised 3 months after placement (JPG 192 kb) (38 kb)
Image 23.5 Perforated left Essure encapsulated in omentum recognised 3 months after placement (JPG 32 kb) (131 kb)
Image 23.6 Perforated left Essure recognised during laparoscopic removal, notice calcified second marker (JPG 129 kb)


  1. 1.
    Janssen FW, Vredevoogd CB, van Ulzen K, et al. Complications of hysteroscopy: a prospective, multicentre study. ObstetGynecol. 2000;96:266–70.Google Scholar
  2. 2.
    Aydeniz B, Wallwiener D, Rimbach S, et al. Is co-administration of ethanol to the distension medium in surgical hysteroscopy a screening method to prevent fluid overload? A prospective randomized comparative study of ablative versus non-ablative hysteroscopy and various ethanol concentrations. GynakolGeburtshilflicheRundsch. 1995;35:108–12.Google Scholar
  3. 3.
    Propst AM, Liberman RF, Harlow BL, et al. Complications of hysteroscopic surgery: predicting patients at risk. ObstetGynecol. 2000;96:517–20.Google Scholar
  4. 4.
    Löffer FD. Complications of hysteroscopy—their cause, prevention, and correction. J Am Assoc Gynecol Laparosc. 1995;3:11–23.CrossRefGoogle Scholar
  5. 5.
    Salat-Baroux J, Hamou JE, Maillard G, et al. Complications from micro hysteroscopy. In: Siegler AM, Lindemann HJ, editors. Hysteroscopy: principles in practice. Philadelphia: JB Lippincott; 1984. p. 112–1.Google Scholar
  6. 6.
    Pellicano M, Guida M, Zullo F, et al. Carbon dioxide versus normal saline as a uterine distension medium for diagnostic hysteroscopy in infertile patients: a prospective, randomized, multicentre study. FertilSteril. 2003;79:418–21.Google Scholar
  7. 7.
    Brusco GF, Arena S, Angelini A. Use of carbon dioxide versus normal saline for diagnostic hysteroscopy. FertilSteril. 2003;79:993–7.Google Scholar
  8. 8.
    Mahmoud F, Fraser IS. CO2 hysteroscopy and embolism. GynaecolEndosc. 1994;3:91–5, 1995; 4:123–127.Google Scholar
  9. 9.
    Brink DM, DeJong P, Fawcus S, et al. Carbon dioxide embolism following diagnostic hysteroscopy. Br J ObstetGynaecol. 1994;101:717–8.CrossRefGoogle Scholar
  10. 10.
    Groenman FA, Peters LW, Rademaker BPM, Bakkum EA. Embolism of air and gas in hysteroscopic procedures: pathophysiology and implication for daily practice. J Minim Invasive Gynecol. 2008;15:241–7.CrossRefGoogle Scholar
  11. 11.
    AAGL. AAGL Practice Report: Practice guidelines for the management of hysteroscopic distending media. JMIG. 2013;20:137–48.Google Scholar
  12. 12.
    Arie AI. Hyponatremia associated with permanent brain damage. Adv Intern Med. 1987;32:325–44.Google Scholar
  13. 13.
    Ayus JC, Wheeler JM, Arie AI. Postoperative hypo-natremic encephalopathy in menstruant women. Ann Intern Med. 1992;117:891–7.CrossRefGoogle Scholar
  14. 14.
    Munro MG. Complications of hysteroscopic and uterine resectoscopic surgery. ObstetGynecolClin North Am. 2010;37:399–425.Google Scholar
  15. 15.
    Dua RS, Bankes MJ, Dowd GS, et al. Compartment syndrome following pelvic surgery in the lithotomy position. Ann R CollSurgEngl. 2002;84:170–1.Google Scholar
  16. 16.
    Erickson TB, Kirkpatrick DH, DeFrancesco MS, et al. Executive summary of the American College of Obstetricians and Gynecologists Presidential Task Force on patient safety in the office setting: reinvigorating safety in office-based gynecologic surgery. ObstetGynecol. 2010;115:147–51.Google Scholar
  17. 17.
    Grimes DA. Diagnostic dilation and curettage: a reappraisal. Am J ObstetGynecol. 1982;142:1–6.CrossRefGoogle Scholar
  18. 18.
    Cooper JM, Brady RM. Intraoperative and early postoperative complications of operative hysteroscopy. ObstetGynecolClin North Am. 2000;27:347–66.Google Scholar
  19. 19.
    Valle RF. Urinary tract, gastrointestinal, and vascular injuries with uterine perforation. In: Hysteroscopic complications and solutions. Postgraduate course syllabus, Int. Cong GynaecolEndosc. 1998:30–35.Google Scholar
  20. 20.
    Sullivan B, Kenney P, Siebel M. Hysteroscopic resection of fibroid with thermal injury to sigmoid. ObstetGynecol. 1992;80:546–7.Google Scholar
  21. 21.
    Brooks PG. Venous air embolism during operative hysteroscopy. J Am AssocGynecolLaparosc. 1997;4:309–422.Google Scholar
  22. 22.
    Hulka JF, Peterson JA, Philips JM, et al. Operative hysteroscopy: American Association of GynecologicLaparoscopists 1993 membership survey. J Am AssocGynecolLaparosc. 1995;2:131–2.Google Scholar
  23. 23.
    Löffer FD. Removing intrauterine lesions: Myomectomy and polypectomy. In: Bieber EJ, Löffer FD, editors. Thegynecologicresectoscope. Cambridge: Blackwell Scientific; 1994. p. 186–94.Google Scholar
  24. 24.
    Goldrath MJ. Uterine tamponade for the control of acute uterine bleeding. Am J ObstetGynecol. 1983;147:869–72.CrossRefGoogle Scholar
  25. 25.
    ACOG Committee on Practice Bulletins—Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2009;113(5):1180–9. Scholar
  26. 26.
    Van Eyk N, van Schalkwyk J, Infectious Diseases Committee. Antibiotic prophylaxis in gynaecologic procedures. SOGC Clinical practice guideline. J ObstetGynaecol Can. 2012;34:382–91.Google Scholar
  27. 27.
    Taskin O, Sadik S, Onoglu A, et al. Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am AssocGynecolLaparosc. 2000;7:351–4.Google Scholar
  28. 28.
    Hill D, Maher P, Wood C, et al. Complications of operative hysteroscopy. GynaecolEndosc. 1992;1:185–9.Google Scholar
  29. 29.
    Löffer FD. Hysteroscopic tubal occlusion. In: Sutton C, Diamond M, editors. Endoscopic surgery for gynaecologists. London: WB Saunders; 1993. p. 345–54.Google Scholar
  30. 30.
    Whitlaw NL, Garry R, Sutton CJG. Pregnancy following endometrial ablation: 2 case reports. GynaecolEndosc. 1992;1:129–32.Google Scholar
  31. 31.
    Polyzos NP, Mauri D, Tsioras S, et al. Intraperitoneal dissemination of endometrial cancer cells after hysteroscopy. A systematic review and meta-analysis. Int J Gynecol Cancer. 2010;20:261–7.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Gynaecologic SurgeryZNA Stuivenberg, Lange BeeldekensstraatAntwerpBelgium
  2. 2.Gynaecologic EndoscopyUniversità degli Studi dell’InsubriaVareseItaly

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