Prevention and Treatment of Fluid Overload in Bipolar Hysteroscopy

Abstract

The most common and serious complication of hysteroscopy is operative hysteroscopy intravascular absorption (OHIA). Bipolar plasma cutting systems are widely used in clinical practice because of their advantages, such as less bleeding, no current through the body, etc. The electrolyte-containing distension solutions can be used with bipolar current electrosurgical devices to avoid hyponatremia. However, complications (e.g., acute heart failure (AHF) and pulmonary edema (PE)) due to excessive absorption of dilating media have been frequently reported. The present study aimed to review the working principle of plasma bipolar hysteroscopy, discuss factors influencing the risk of fluid overload, and compare the absorption of uterine distension fluid during hysteroscopy with the values of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) in the diagnosis of fluid overload in bipolar hysteroscopy. Real-time bedside ultrasound, which is a reliable and non-invasive method to identify cardiac function and pulmonary hyperemia, can make early diagnosis of fluid overload in bipolar hysteroscopy of patients with AHF and PE, and even move the diagnostic threshold forward. We also described inferior vena cava (IVC) ultrasound and volume reactivity, systolic and diastolic functions of the left heart, peak velocity and velocity time integral of aorta, size of the right heart, systolic function of the right heart, diastolic function recognition, and their relationship with PE in AHF caused by fluid overload. In summary, combination of cardiopulmonary ultrasound and IVC ultrasound can be a sensitive indicator for the early diagnosis of AHF and PE caused by fluid overload in bipolar hysteroscopy, while further clinical experiments need to be conducted to verify this conclusion.