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Whereas the preferred distending solution should be isotonic and isonatremic, radiofrequency (RF) electrosurgery with monopolar instrumentation can only be performed with non\u2010ionic (hyponatremic) solutions. Absorption of as little as 500\u2009mL and certainly more than 1000\u2009mL of non\u2010ionic solutions can result in fluid overload and\/or dilutional hyponatremia with potentially serious adverse effects under certain conditions and patient characteristics. Both hysteroscopic RF electrosurgery with bipolar instrumentation and electro\u2010mechanical morcellation and aspiration systems use isotonic and isonatremic solutions. Depending on the clinical context, absorption of more than 1500\u2009mL of isonatremic solutions can also result in serious adverse effects. Automated fluid management systems are preferred and recommended, and surgeons should aim to maintain the maximum allowable intravasation of distending media below 1000 and 1500\u2009mL for non\u2010ionic and ionic fluids, respectively.<\/jats:p>","DOI":"10.1002\/ijgo.15860","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T19:29:48Z","timestamp":1724354988000},"page":"118-125","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Good practice with fluid management in operative hysteroscopy"],"prefix":"10.1002","volume":"168","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2007-8791","authenticated-orcid":false,"given":"George A.","family":"Vilos","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelos G.","family":"Vilos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basim","family":"Abu\u2010Rafea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artin","family":"Ternamian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Laberge","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Universit\u00e9 Laval  Quebec City Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm G.","family":"Munro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA  California Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-3804(98)80011-X"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)57961-8"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12410"},{"key":"e_1_2_12_5_1","first-page":"104","article-title":"Vascular factors in dysmenorrhea","volume":"9","author":"Sanchez Ibanez JM","year":"1950","journal-title":"Rev Esp Obstet Ginecol"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-3804(96)80068-5"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-3804(05)60474-4"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000230214.26638.0c"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00726-013-1493-1"},{"issue":"2","key":"e_1_2_12_10_1","first-page":"218","article-title":"Changes in serum electrolytes after transcervical resection of endometrium and submucous fibroids with use of glycine 1.5% for uterine irrigation","volume":"80","author":"Istre O","year":"1992","journal-title":"Obstet Gynecol"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200008000-00021"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-117-11-891"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00502.2007"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-3804(98)80076-5"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2008.09.077"},{"key":"e_1_2_12_16_1","first-page":"1","article-title":"Death from acute hyponatremia following uneventful abdominal hysterectomy: lessons from a case report","volume":"2","author":"Vilos GA","year":"2019","journal-title":"W J Gynecol"},{"issue":"4","key":"e_1_2_12_17_1","first-page":"740","article-title":"Intrauterine surgery using a new coaxial bipolar electrode in normal saline solution (Versapoint): a pilot study","volume":"72","author":"Vilos GA","year":"1999","journal-title":"Fertil Steril"},{"issue":"1","key":"e_1_2_12_18_1","first-page":"47","article-title":"Complications associated with monopolar resectoscopic surgery","volume":"12","author":"Vilos GA","year":"2020","journal-title":"Facts Views Vis Obgyn"},{"key":"e_1_2_12_19_1","unstructured":"Hospital sanctioned for death during hysteroscopy.Healthcare Risk Management.March 1 2000. 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