Objectives: Adverse events associated with large volumes of distending media in hysteroscopic procedures can be life-threatening. The aim of this study was to evaluate the safety and efficacy of manual syringe infusion (MI) of distending media for hysteroscopic procedures.Study design: Between January 2011 and December 2013, the medical records of all women who underwent hysteroscopic procedures using MI or the conventional pump-infusion method (PI, the control group) were reviewed. The Wilcoxon rank-sum test, the Chi-square test and the multivariate logistic regression analysis were employed for statistical analysis.Results: The MI group (n = 82) had a significantly lower average volume of infused fluid (1117 +/- 712 mL vs. 2216 +/- 1502 mL, respectively; p < 0.001), less operative time (22.2 +/- 9.7 vs. 30.4 +/- 9.8 min, respectively; p < 0.001) and lower postoperative abdominal pain scores (0.6 +/- 0.7 vs. 0.8 +/- 0.7, respectively; p = 0.04) than the PI group (n = 58). Subgroup analysis of women who underwent hysteroscopic myomectomy revealed a significantly lower amount of infused fluid for the MI group than for the PI group (1737 +/- 905 mL vs. 3441 +/- 1952 mL, respectively; p = 0.001). Infused fluid amount (coefficient = 0.08, p < 0.001) was the only significant independent factor affecting fluid deficit, with a constant of 76.1.Conclusion: The MI method appears to be a safe and feasible method for delivering distending media during hysteroscopic procedures. (C) 2015 Elsevier Ireland Ltd. All rights reserved.