BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy

Hysteroscopy enables visualisation of the uterine cavity and allows the diagnosis and surgical treatment of intrauterine pathology. To achieve this, the uterine cavity needs to be distended by a medium which could either be fluid or carbon dioxide [ 1 ]. Carbon dioxide is used for diagnostic hysteroscopy, as bleeding during operative procedures obscures visibility. For this reason, fluid media are used for operative procedures, as they allow continuous irrigation giving a clear picture and enable use of both mechanical and electrosurgical instruments. During operative hysteroscopy absorption of large volumes of distension solutions can occur leading to serious complications arising from significant fluid overload. Excessive fluid absorption is most likely with prolonged hysteroscopic procedures requiring continuous irrigation of fluid or where blood vessels within the myometrium are opened. Thus, particular care is required with resection of the endometrium (transcervical resection of the endometrium – TCRE) and hysteroscopic myomectomy – transcervical resection of fibroids – TCRF).