Complications of hysteroscopy: A prospective, multicenter study

Objective: To estimate the incidence of complications of diagnostic and ope rative hysteroscopic procedures in the Netherlands and describe their natur e. Methods: Data on complications were recorded by 82 hospitals in 1997. Parti cipating hospitals had a 100% response rate. Any unexpected events that req uired intraoperative or postoperative intervention were defined as complica tions in two groups: approach (entry-related) and technique-related (caused by surgical instruments). Results: Thirty-eight complications occurred among 13,600 hysteroscopic pro cedures (rate 0.28%). Diagnostic hysteroscopic procedures had a significant ly lower complication rate (0.13%) than operative procedures (rate 0.95%; P < .01). Fluid overloads of distention medium were recorded five times (rat e 0.20%). The most frequent surgical complication was perforation of the ut erine cavity (rate 0.76%). Approximately half the perforations (18 of 33) w ere entry-related. Bleeding caused by perforation was seen in 0.16% of case s. Incidences of complications were: intrauterine adhesiolysis 4.48%, endom etrium resection 0.81%, myomectomy 0.75%, and removal of a polyp 0.38%. Conclusion: Diagnostic hysteroscopic procedures had very low complication r ates, so are safe procedures with which to evaluate intrauterine pathology. Operative hysteroscopic procedures were more risky, but the removal of pol yps had a very low complication rate (12 times lower than synechiolysis). H alf the complications were entry-related, so attention has to be paid to th e method of entry with the hysteroscope (ie, no unnecessary dilation of cer vix and introduction of the scope under direct vision). The other half of c omplications were related to surgeons' experience and type of procedure. (( C) 2000 by The American College of Obstetricians and Gynecologists.).