Case-control study of complications associated with bipolar and monopolar hysteroscopic operations

Abstract

Study objective: To examine whether all hysteroscopic operations can be performed using bipolar technology and to compare the complication rates of hysteroscopic surgery performed using monopolar and bipolar technology.

Design: Case-control study (Canadian Task Force classification II-2).

Setting: Endoscopic gynecology unit at a tertiary-care university hospital.

Patients: Women aged 17 to 88 years (median, 43.9 years) who underwent operative hysteroscopy to treat uterine disease.

Interventions: Operative hysteroscopy using bipolar technology and normal saline solution as irrigation medium. The control group was composed of women who underwent the procedure using monopolar technology, with glycine as irrigation medium, before adoption of bipolar technology.

Measurements and main results: Data regarding short-term complications were prospectively obtained during surgery and at 2-week follow-up. More than 1800 procedures were investigated (1318 in the study group and 524 in the control group). The complication rate was 4.1% in the study group and 2.8% in the control group (p = .08).

Conclusion: Both monopolar and bipolar hysteroscopic techniques are safe and feasible. The bipolar hysteroscopic system has eliminated the need to use hypotonic solutions as irrigation medium, with its life-threatening complications. When limiting normal saline solution to 2 L, no serious complications associated with irrigation medium are expected. Therefore, we believe that when available, the bipolar system should be preferred.