••• Chapter 57^ Laparoscopy and Infertility Surgery^571
❍ What is the osmolarity of these solutions?
1.5% glycine and 3% sorbitol: Hypo-osmolar.
5% mannitol and 2.2% glycine: Iso-osmolar.
❍ What is the safest hysteroscopic medium?
Normal saline (0.9% sodium chloride).
❍ What is a dangerous fluid deficit with the use of glycine?
A fluid deficit of ≥500 mL is associated with increased risk of hyponatremia and hypo-osmolality.
❍ What is the advantage of Hyskon over other media?
It is immiscible with blood. This allows for excellent visualization, even during active bleeding.
❍ What are potential complications of Hyskon use?
Idiosyncratic anaphylactoid reaction, hypervolemia, hyponatremia, pulmonary edema, and bleeding diathesis.
❍ What is the maximum volume of Hyskon that can be used during a single case?
500 mL. Above that, the incidence of pulmonary edema has been described as high as 1.4%.
❍ Name four conditions that can be treated hysteroscopically.
Submucosal fibroid, endometrial polyp, uterine adhesions, and uterine septum.
❍ What is the recurrence rate of endometriomas after surgical treatment?
The recurrence rate is approximately 10% to 20%.
❍ Name two laparoscopic procedures for management of chronic pelvic pain.
LUNA (laparoscopic uterosacral nerve ablation) and presacral neurectomy.
❍ What is the term pregnancy rate following laparoscopic salpingoneostomy?
Rates vary widely but average around 15%.
❍ What is the ectopic pregnancy rate following laparoscopic salpingoneostomy?
Up to 40% of all pregnancies.
❍ What is the incidence of finding pelvic pathology during a laparoscopy for an infertility evaluation?
It is reported between 25% and 75%.
❍ Does laparoscopic treatment of endometriosis increase pregnancy rates?
This is a controversial area. In early-stage disease, there is some evidence that pregnancy rates improve
postoperatively.