Safety Issues of Hysteroscopic Surgery MINAS PASCHOPOULOS, NIKOLAOS P. POLYZOS, LAZAROS G.LAVASIDIS, THOMAS VREKOUSSIS, NIKOLAOS DALKALITSIS, AND EVANGELOS PARASKEVAIDIS Department of Obstetrics and Gynaecology, Endoscopic Unit, University of Ioannina School of Medicine, Ioannina, Greece ABSTRACT: The term hysteroscopy is used to determine the procedure during which an endoscopic view of the endometrial cavity is achieved with the help of a type of endoscopic device called “the hysteroscope.” Hysteroscopy is used to assist the diagnosis for a series of female pathol- ogy. Apart from its diagnostic value, hysteroscopy can also be used for operative procedures including ablation and resection. Both diagnostic and operative hysteroscopy have been used for a number of years and various studies have been published to describe their success and compli- cation rates throughout this period. Diagnostic hysteroscopy is relatively safe, whereas complications occur more frequently when operative hys- teroscopy is used. These complications include uterine perforation, hem- orrhage, fluid overload, gas embolization, and hyponatremia. The rate in the appearance of these complications is dependent on the type of the hys- teroscopic procedure, the distending medium, and the experience of the hysteroscopist. To avoid any problems concerning the application of hys- teroscopic procedures, it is important to take the necessary precautions both preoperatively and intraoperatively. For example, the preoperative use of thinning agents of the endometrium and the reduction of the oper- ating time, or the avoidance of cutting too deeply into the myometrium, are some of the parameters to be considered when hysteroscopy is in argument. KEYWORDS: hysteroscopy; complications; perforation; hemorrhage; gas embolization; fluid overload; hyponatremia; review INTRODUCTION Hysteroscopy is the procedure during which a view of the endometrial cav- ity can be achieved with the use of especially designed instrumentation. The endoscopists can identify focal uterine lesion or assess the severity of an ex- panded pathology. At the same time, there can also be a therapeutic interven- tion; in this way, hysteroscopy is considered to be a modern method for the Address for correspondence: Minas Paschopoulos, M.D., Department of Obstetrics and Gynaecology, University of Ioannina School of Medicine, Ioannina 45110-Greece. Voice: +30-26510-99302; fax: +30-26510-99224. e-mail: mpasxop@cc.uoi.gr Ann. N.Y. Acad. Sci. 1092: 229–234 (2006). C  2006 New York Academy of Sciences. doi: 10.1196/annals.1365.019 229