Outpatient hysteroscopic polypectomy in 237 patients: feasibility of a one-stop "see-and-treat" procedure.
OBJECTIVE
To evaluate the feasibility of a "see-and-treat" office polyp resection, using a 5-mm sheathed operative hysteroscope.


METHODS
Retrospective study (Canadian Task Force classification II-2).


METHODS
Public hospital.


METHODS
Two hundred thirty-seven patients suffering from endometrial polyps who underwent outpatient hysteroscopy.


METHODS
Office polypectomy with anesthetic paracervical block (120 patients) or without (117 patients) using either mechanical (104 patients) or bipolar coaxial electrosurgical (107 patients) instrumentation. In 26 patients, we stopped the procedure before surgery because of intervening adverse events or polyps judged unresectable with an office-based procedure. A 10-cm visual analog scale (VAS) was used to rate patients' pelvic pain perception.


RESULTS
Overall effective polyp resection rate was 81.2% (191 of 235 evaluable patients). An inverse, although not significant (r = -.44) correlation was found between accomplished polypectomies and polyp size, ranging from 96.0% to 18.7% when the diameter of polyps was below 1 cm and above 4 cm, respectively (50 of 52 and 3 of 16 successfully accomplished procedures, respectively). No significant differences were found between successful resection rates (83.3% and 80.2%, respectively; p = .10) and VAS scores (2.2 +/- 2.6 and 3.6 +/- 2.9, respectively; p = .30) obtained in 79 premenopausal and 156 postmenopausal patients. Paracervical block administration (118 evaluable patients) matched with no anesthetic support (117 patients) was not associated either with an improved rate of resection (85.5% and 76.9%, respectively; p = .10) or with pelvic pain perception (VAS scores 3.3 +/- 2.9 and 3.0 +/- 2.8, respectively; p = .94). Visual analog scale scores were significantly lower (2.8 +/- 2.5 and 4.7 +/- 3.6, respectively; p = .001) and polyp resection rates were significantly higher (84.3% and 67.4%, respectively; p = .01) in 192 parous versus 43 nulliparous patients. Polypectomy failed in 44 of 235 patients (18.7%); the leading causes of failure were intolerable pelvic pain in 18 patients (7.6%) and polyp size in 17 patients (7.2%). Other than pelvic pain, the only adverse event we observed was clinical vasovagal reaction in four patients (1.7%).


CONCLUSIONS
One-stop outpatient hysteroscopic polypectomy is effective in about 80% of patients. With proper preoperative selection, it can be offered as a reliable option to avoid general anesthesia and resectoscopic surgery.
Garuti
Giancarlo
G
Department of Obstetrics and Gynecology, Lodi Hospital, via Savoia No. 1, 26900-Lodi, Italy.
Cellani
Fulvia
F
Colonnelli
Monica
M
Grossi
Francesco
F
Luerti
Massimo
M
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D004717:Endometrium / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D011127:Polyps / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery