Operative hysteroscopy — distension media, fluid management, energy and complications

It is a busy day-case list and your next patient is a 64-year-old with postmenopausal bleeding and a 2 cm polyp. You plan a hysteroscopic polypectomy with a resectoscope and glycine. The numbers on the fluid pump are climbing faster than you like, and the anaesthetist mentions the sodium on the gas machine. Hysteroscopy looks gentle — it is transvaginal, small, quick — but the distending medium you need to see is the same medium that can drop a sodium and swell a brain. This topic is your rehearsal for the cavity, the pump and the sodium.[13][14]

Overview and definition

Hysteroscopy inserts a rigid or flexible scope through the cervix and distends the uterine cavity with a medium so you can see and operate — the gold standard for evaluating and managing intrauterine pathology, from abnormal uterine bleeding to infertility, retained products and müllerian anomalies.[14][15] Polypectomy is the most common hysteroscopic procedure worldwide.[14]

The operative spectrum runs from the resectoscope (a loop electrode for monopolar or bipolar resection) to the mechanical hysteroscopic tissue-removal (mHTR) systems that morcellate without energy, and the mini-hysteroscope that needs no dilation for office work.[14] Two settings bookend the practice: the outpatient "see-and-treat" office and the operating-room day-case under anaesthesia.[8][15]

References15Show ledgerHide ledger

1. [1]Munro MG, Storz K, Abbott JA, et al. AAGL Practice Report: Practice Guidelines for the Management of Hysteroscopic Distending Media J Minim Invasive Gynecol, 2013.PMID 23465255
2. [2]Abdallah KS, Gadalla MA, Breijer M, Mol BWJ Uterine distension media for outpatient hysteroscopy Cochrane Database Syst Rev, 2021.PMID 34826139
3. [3]Umranikar S, Clark TJ, Saridogan E, Miligkos D, Arambage K, Torbe E, Campo R, Di Spiezio Sardo A, Tanos V, Grimbizis G BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy Gynecol Surg, 2016.PMID 28003797
4. [4]Aydeniz B, Gruber IV, Schauf B, Kurek R, Meyer A, Wallwiener D A multicenter survey of complications associated with 21,676 operative hysteroscopies Eur J Obstet Gynecol Reprod Biol, 2002.PMID 12206931
5. [5]Calabrese S, DE Alberti D, Garuti G The use of bipolar technology in hysteroscopy Minerva Ginecol, 2016.PMID 26928415
6. [6]De Silva PM, Stevenson H, Smith PP, Clark TJ Pain and Operative Technologies Used in Office Hysteroscopy: A Systematic Review of Randomized Controlled Trials J Minim Invasive Gynecol, 2021.PMID 34089888
7. [7]Cooper NA, Smith P, Khan KS, Clark TJ Does cervical preparation before outpatient hysteroscopy reduce women's pain experience? A systematic review BJOG, 2011.PMID 21797959
8. [8]Bennett A, Lepage C, Thavorn K, Fergusson D, Murnaghan O, Coyle D, Singh SS Effectiveness of Outpatient Versus Operating Room Hysteroscopy for the Diagnosis and Treatment of Uterine Conditions: A Systematic Review and Meta-Analysis J Obstet Gynaecol Can, 2019.PMID 30528838
9. [9]Lethaby A, Penninx J, Hickey M, Garry R, Marjoribanks J Endometrial resection and ablation techniques for heavy menstrual bleeding Cochrane Database Syst Rev, 2013.PMID 23990373
10. [10]Vitale SG, Sapia F, Rapisarda AMC, Valenti G, Santangelo F, Rossetti D, Chiofalo B, Sarpietro G, La Rosa VL, Triolo O, Noventa M, Gizzo S, Laganà AS Hysteroscopic Morcellation of Submucous Myomas: A Systematic Review Biomed Res Int, 2017.PMID 28948169
11. [11]Haber K, Hawkins E, Levie M, Chudnoff S Hysteroscopic morcellation: review of the manufacturer and user facility device experience (MAUDE) database J Minim Invasive Gynecol, 2015.PMID 25128851
12. [12]Luerti M, Vitagliano A, Di Spiezio Sardo A, et al. Effectiveness of Hysteroscopic Techniques for Endometrial Polyp Removal: The Italian Multicenter Trial J Minim Invasive Gynecol, 2019.PMID 30528831
13. [13]Sethi N, Chaturvedi R, Kumar K Operative hysteroscopy intravascular absorption syndrome: A bolt from the blue Indian J Anaesth, 2012.PMID 22701213
14. [14]Moore JF, Carugno J Hysteroscopy StatPearls, 2026.PMID 33232015
15. [15]American College of Obstetricians and Gynecologists (ACOG) The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800 Obstet Gynecol, 2020.PMID 32080054