Ways to prevent air embolism during hysteroscopy

Objective. To improve methods to prevent air embolism (AE) during hysteroscopy with consideration for accumulated clinical experience. Subject and methods. A longitudinal observational retrospective case-control study was conducted at the S.P. Botkin City Clinical Hospital. The course of hysteroscopic interventions and the development of AE were analyzed examining the case histories of 4590 women aged 19 to 85 years with intrauterine pathology (IUP) who had undergone hysteroscopy in January 2010 to January 2013, including 815 (17.8%) who had hysteroresectoscopy. The findings were processed using a package of Statistica programs for Windows 6.0 Stat-Soft. Results. During the study, the development of AE was not observed in the patients with IUP during hysteroscopy. Owing to the fact that that the technology of liquid hysteroscopy was strictly observed, there were even no conditions for AE occurrence in 3750 (81.7%) women with IUP without electrosurgical interventions. To rule out AE requires that a delivery hose system and a hysteroscope should be freed of air bubbles and, where possible, liquid feeding systems using air pressure be abandoned. Where resected tissue segments must be removed from the uterine cavity, the prevention of AE involves the creation of conditions for free evacuation of air bubbles from the uterine cavity. The hysteroscope is inserted assembled with pre-supplied liquid and the tap of the outflow system being fully open. Environmental air aspirations are possible when Trendelenburg’s position is used in combination with the open outer resectoscope barrel left in the cervical canal (for example, electrode replacement); the prevention is to close the lumen of the outer barrel with a mandrin.

air embolism, intrauterine pathology