Possible complications of hysteroscopic surgery
Although hysteroscopy has many important advantages over conventional procedures such as laparotomy (no external incisions, less postoperative discomfort, short hospitalisation, faster recovery, etc), it is still a surgical procedure, and all surgical procedures carry a risk of complications. Complications are, however, relatively uncommon with hysteroscopy but they can be serious and in very rare instances, even life-threatening.
After Janset et al. Complications of hysteroscopy: A prospective multicenter study 2000, 96, 266-70.
Uterine perforation Uterine perforation, that is a full thickness tear through the muscle wall of the womb, is one of the most feared complications as it can be associated with injury to bowel, bladder or blood vessels in the abdomen. If it happens, hysteroscopic surgery is stopped immediately, and a laparoscopy (endoscopic investigation of the abdomen) or laparotomy may have to be carried out.
Fluid overload The womb has to be distended with fluid under quite a high pressure to provide a clear view of the uterine cavity during surgery. It is normal for some of this fluid to be absorbed during the procedure, but this is of no consequence as long as the volume is not excessive. Absorption of large volumes of distention fluid is referred to as fluid overload, and as with uterine perforation, means that the surgery has to be stopped immediately. Fluid overload is usually treated with diuretic injections.
Haemorrhage Intra-operative bleeding is a rare complication of hysteroscopic surgery but if it occurs, a laparotomy and even hysterectomy may have to be done to stop the blood loss. In lesser cases, it is usually sufficient to place a water-filled balloon inside the uterus to tamponade the bleeding vessel for a few hours.
Infection, air embolism and cervical tears are other uncommon complications.