Objective: Complications of operative hysteroscopy (OH) are rare and usually minor. However, in rare cases, certain complications such as gas embolism (GE) can be life-threatening. The objective of this study was to analyze the circumstances and outcomes of GE cases occurring during OH.

Materials and methods: This retrospective descriptive observational study included all cases of GE during OH reported between 2016 and 2023 in the experience feedback (REX) database of Gynerisq, an organization accredited in risk management in Gynecology and Obstetrics by the French National Authority for Health (HAS).

Results: Among 318 reported OH complications, 14 cases of GE were identified (4.4%). The procedures involved fibroid resection in 11 patients (78.6%) and endometrectomy in 3 patients (21.4%). Bipolar energy was used in all cases. Of the 14 GE cases, 5 had serious consequences, including cardiac arrest and intensive care unit (ICU) admission. Eight cases were considered probably avoidable by the reporting practitioners, particularly due to non-compliance with the recommendations of the French National College of Gynecologists and Obstetricians (CNGOF), such as unpurged tubing and failure to monitor intrauterine pressure.

Conclusion: This analysis shows that all reported GEs occurred during procedures using bipolar energy and following fibroid or endometrial resection. However, a causal relationship between bipolar energy and GE cannot be established. Further studies are required to assess the role of bipolar energy and the conditions of its use in the occurrence of GE.