PubMed2002
In the last couple of years operative hysteroscopy has become a very popular surgical method. It provides us with the possibility to visualize the uterine cavity and explore it with absolute accuracy. In the majority of world centers, it is performed in ambulance. This is a very simple and financially acceptable method, for it does not require special pre and post operative treatments. Of course, simplicity of the procedure, the result, as well as the possibility of complications, depends on the surgeon as well as the preceeding diagnostics. In the period from September of 1997, to September of 1998., 320 operative hysteroscopies were performed in the Clinic for Gynaecology and Obstetrics in Sarajevo. All 320 patients were submitted for infertility. Detailed anamnesis was taken for each patient (HSG, diagnostic laparoscopy, operative laparoscopy, IVF). Each patient in our program was also subject to transvaginal Color Doppler diagnostics before the operation. This form of diagnostics turned out to be highly sensitive and highly specific. We used "Stortz" equipment, including an 8 mm resectoscope and OTV endocamera. Uterine distension was achieved through constant flow of "Purisol" solution. Prior to hysteroscope introduction, we dilated the cervical tube using Hegar metal dilatator. All patients were in general ET anesthesia. We divided complications in two groups: early and late complications. Depending on the sort of complication, patients were hospitalized from 1 to 7 days. Early complications occurred in 7 patients: unsuccessful cervical dilatation--2 patients; uterus perforation--1 patient; uterine bleeding--3 patients; intravasation--1 patient. Impossibility to finish the operation was also considered a complication: impossibility of septum incision--1 patient; incomplete myoma enucleation--1 patient; impossibility to reconstruct womb in the whole--1 patient. Late complications are those that appeared 12-24 hours after the operation: post-operative bleeding--2 patients; increased body temperature--2 patients; pain in lower abdomen--4 patients.