[Hysteroscopy syndrome. Absorption of irrigation fluid in surgical hysteroscopy]

The availability of adequate endoscopic instruments has led to an increased interest in hysteroscopic surgical procedures. An electrolyte-free irrigation fluid is essential for the distention of the uterine cavity, with acceptable uterine distention occurring at 80-150 mmHg. The HSK syndrome, the intravascular absorption of a hypotonic irrigation fluid with subsequent hypotonic hyperhydration with hyponatremia, has to be considered as a risk during hysteroscopic procedures. Analogous to the TUR syndrome, intravasation occurs through the vascular spaces opened during large ablative surgical procedures resulting in the absorption of the fluid used for irrigation. Occasionally, a tear in the lower uterine segment from dilation or perforation of the uterus may expose large vascular channels. Outflow through the tubes is not a significant factor. Continuous CVP measurement allows the detection of intravascular absorption of the irrigation fluid and may be included in the routine monitoring for these procedures. The duration of the hysteroscopic procedure should be limited to 60 min. Addition of ethanol to the irrigating fluid may be suitable for early detection of fluid absorption. However, commercial solutions are not yet available.