Excessive distension absorption in patient went through hysteroscopic
surgery distended with 5%mannitol solution : a retrospective study.
Abstract
Objective: To estimate the incidence of excessive distension absorption
in the patient went through hysteroscopic surgery distended with 5%
mannitol solution, to evaluate the use of 5% mannitol solution for
hysteroscopic surgical procedure specifically and to testify the safe
threshold for distension absorption. Design: Retrospective. Setting:
Academic medical center. Patients: 10693 patients went through inpatient
hysteroscopic surgery distended with 5% mannitol solution using
monopolar electrosurgical instrument from Jan. 2015 to Sep. 2020.
Intervention(s): None. This study has been approved by the Ethics
Committee of Sun Yat-sen Memorial Hospital. Measurements and Main
Results: Fluid deficit more than 1000mL is defined as excessive
distension absorption. Incidence of excessive distension absorption in
all the inpatient hysteroscopic surgeries is 0.46% (49/10693). It is
2.57% (16/623) in transcervical resection of fibroid (TCRF), 2.36%
(9/381) in retained products of conception (RPOC) removal, 1.20%
(6/501) in hysteroscopic uterine septum resection (HSR), 0.53%
(14/2621) in transcervical resections of adhesion (TCRA) while in the
severe cases it was 2.34% (14/598), 0.48% (4/828) in transcervical
resection of the endometrium (TCRE). Excessive distension absorption
developed within ten minutes in two cases. Twelve of thirty nine
patients with fluid deficit under 2500mL presented with clinical
consequences related to circulation overload. Conclusion: Incidence of
excessive distension absorption could be low generally however it would
be five times higher in TCRP, RPOC removal and TCRA. Resection by needle
electrode may contribute to the excessive distension absorption
developed within short time. 30.77% of the patients could not tolerate
the less than 2500mL distension absorption.