hysteroscopy_complications.pptVIP

Complications of hysteroscopy INTRODUCTION Complications may occur in diagnostic or operative hysteroscopy. The complication rate in diagnostic hysteroscopy is low and was estimated by Lindemann (1989) to be 0.012% . Complications from operative hysteroscopy are more common and potentially more serious. Complications may result from (Taylor Gordon, 1994): Anesthesia Positioning the patient The distension media The surgery: Uterine perforation Haemorrhage Delayed complications: Infection Adhesion formation Failure of resolution of the presenting symptoms THE ANAESTHETIC The risks to the patient from the anesthetic are similar to those from any other operation. The complications which are specific to hysteroscopic surgery are those which may present as shock resulting from: Uterine perforation or Injury to a major vessel or from Fluid overload. THE ANAESTHETIC The anesthetist may be the first to recognize the onset of danger and may recommend that the surgeon discontinue the procedure and to institute appropriate treatment. POSITIONING THE PATIENT Incorrect positioning of the patient may result in: Nerve injuries Back injuries Damage to soft tissues Deep venous thrombosis (DVT) 1. Nerve Injuries The degree of Trelendenberg tilt required for hysteroscopic surgery is less than that for operative laparoscopy. Brachial plexus injury may result from incorrectly placed shoulder restraints or from leaving the patients arm abducted on an arm board. A non-slip mattress is preferable to restraints that compress the patients shoulders. Injury can result from 15 minutes in a faulty position. 1. Nerve Injuries Pressure on the peroneal nerve by lithotomy stirrups may result in paraesthesia and foot drop. If lithotomy poles are used, the legs are adequately padded. Supports which hold the leg in a padded gutter are preferable. If injury occur, the advice of a neurologist should be sought immediately. 2. Back injuries. The anaesth