The Influence of Solution Temperature on Fluid Deficit During Hysteroscopy

INTRODUCTION: The application of warm distension fluid has been recently used in office hysteroscopy in order to reduce pain. However, warm irrigation solution might be limiting the procedure duration due to expected expansion of the vascular system, resulting in a higher fluid deficit in shorter time. Reports describing the clinical association between the irrigation fluid temperature to the intravasation rate, and the risk of fluid overload are limited and mainly based on theoretical models. OBJECTIVE: The aim of the study is to evaluate the association between the irrigation fluid temperature on the fluid deficit during hysteroscopic procedures using two different temperature setups: 24 °C (room temperature) and 37 °C (body temperature). METHODS: This is a randomized controlled study conducted at a single tertiary university-affiliated medical center. The study population included all women scheduled for operative hysteroscopy due to preoperative diagnoses of polyps, endometrial thickening, or uterine fibroids (FIGO classification: type 0, 1, or 2). A TruClear™ hysteroscope was utilized with 0.9% saline solution as the expanding medium. Two temperatures were tested: room temperature (approximately 24 °C) and 37 °C (body temperature). Participants were randomly assigned to one of the two arms and were blinded to their assignment. RESULTS: A total of 91 women met inclusion criteria; of them, 44 (48%) in the room temperature group and 47 (52%) in the body temperature group. 5 (11%) women in each group were operated due to suspected fibroids (p=0.91). The median age and BMI were comparable between the groups. Mini TruClear™ hysteroscope was used in 93% vs. 91% of the procedures in the room temperature and the body temperature groups, respectively (p=0.76). Tissue shaver use was also similar between the groups [25 (57%) vs. 31 (66%) procedures, respectively; p=0.53]. While comparing the time to reach 100-cc fluid deficit, no significant differences were observed [52 (23–200) vs. 60 (23–106) seconds; p=0.31]. However, a trend of a higher visual analog pain score (VAS) was reported by the women in the room temperature group compared to the warmed fluid group [4 (0–6) vs. 1 (0–6); p=0.38]. CONCLUSIONS: Fluid temperature did not significantly influence the fluid deficit during hysteroscopy. Similar findings were observed for fibroid and non-fibroid indicated procedures.