Complications of Hysteroscopy
At any phase of operative hysteroscopy, a complication can occur. Obviously, it is best to avoid complications; however, if such an event happens, then recognition is mandatory. Because operative sheaths are large, cervical dilation is required to permit entry of the hysteroscope into the uterus. Perforation of the uterus may happen during dilation (Fig. 112–1). A diagnostic laparoscopic exam will allow the surgeon to determine whether to repair the injury. If bleeding continues after a reasonable clotting time, then the uterine wound should be sutured. Perforation may occur during intrauterine operations. If the injury results from the use of conventional tools (e.g., hysteroscopic scissors), then a laparoscopic view of the injury and surrounding viscera is acceptable (Fig. 112–2). If no continuing bleeding is observed, then no repair is required. If bleeding continues or is pulsatile in nature, then the wound must be hemostatically sutured (figure-of-8). When an energy device perforates the uterus (laser fiber or electrosurgical device), then laparotomy is necessary (Fig. 112–3). The surrounding intestine must be carefully and methodically inspected to determine whether a hole has been made in the small or large bowel (Fig. 112–4A, B). Similarly, the urinary tract and great vessels should be examined for injury.
