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The uterine cavity is a potential cavity and requires to become distended to permit for inspection. Thus during hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice would depend on the procedure, the patient’s condition, and also the physician's preference. Fluids may be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, that could result in the imaging visualization difficult. Gas embolism could also arise like a complication. Because the success of the procedure is completely depending on the quality of the high-resolution video images before surgeon's eyes, CO2 gas isn't popular as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s solution.
Current recommendation is by using the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they are conducting electricity, these fluids should not be combined with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol along with a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. All these distention fluids is associated with unique physiological changes that should be considered when choosing a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose within the liver and is contraindicated if a patient has fructose malabsorption. High-viscous Dextran also has potential complications which may be physiological and mechanical. It might crystallize on instruments and obstruct the valves and channels.
Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and may cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% includes a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) ought to be avoided in patients with fructose malabsorption.
