title: A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results.
abstract: OBJECTIVE
  To assess and compare efficacy, pain, and the learning curve associated with diagnostic therapeutic hysteroscopy using mechanical tissue removal versus bipolar electrical resection in the management of endometrial polyps in an ambulatory care setting.
  
  
  METHODS
  A randomized controlled clinical trial (Canadian Task Force classification I).
  
  
  METHODS
  Hospital de Igulada, Barcelona, Spain.
  
  
  METHODS
  A total of 133 patients diagnosed with endometrial polyp(s) were included and randomly assigned to 1 of the 2 hysteroscopic methods. Criteria assessed were total hysteroscopy time, full polypectomy procedure time, pain experienced by patients, and learning curve of staff in training.
  
  
  RESULTS
  The average time to perform total hysteroscopy using the mechanical tissue removal system (TRUCLEAR 5.0 System; Smith & Nephew Inc., Andover, MD) was 6 minutes 49 seconds versus 11 minutes 37 seconds required for the bipolar electrosurgery system (GYNECARE VERSAPOINT; Ethicon Inc, Somerville, NJ) (p < .01). Results for complete polypectomy time favored the TRUCLEAR System at 3 minutes 7 seconds over the VERSAPOINT System at 8 minutes 25 seconds (p < .01). If a successful procedure is predicated on access to cavity, visualization, and complete resection and excision of endometrial polyp, the mechanical TRUCLEAR Tissue Removal System shows a higher success rate than the VERSAPOINT Bipolar Electrosurgery System at 92% and 77%, respectively. Analysis of pain using the visual analog scale revealed no significant differences between the 2 techniques (p > .05). A study of the residents' learning curve showed a higher level of autonomy with hysteroscopy using the TRUCLEAR Tissue Removal System with which residents showed a higher level of confidence compared with hysteroscopy with the VERSAPOINT Bipolar Electrosurgery System.
  
  
  CONCLUSIONS
  In hysteroscopic polypectomy, the mechanical tissue removal system was significantly faster, achieved a greater success rate for complete polypectomy, and required a shorter learning curve from staff being trained in the management of endometrial polyps when compared with bipolar electrical resection.
authors.affiliation: Department of Obstetrics and Gynecology, Igualada Hospital, Consorci Sanitari de l'Anoia,Igualada, Barcelona, Spain. Electronic address: jenny_rovira@yahoo.com.
authors.forename: Jennifer Rovira
authors.initials: JR
authors.lastname: Pampalona
authors.affiliation: Department of Obstetrics and Gynecology, Igualada Hospital, Consorci Sanitari de l'Anoia,Igualada, Barcelona, Spain.
authors.forename: Maria Degollada
authors.initials: MD
authors.lastname: Bastos
authors.affiliation: Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Spain.
authors.forename: Gemma Mancebo
authors.initials: GM
authors.lastname: Moreno
authors.affiliation: Department of Epidemiology and Assessment, Hospital del Mar and Medical Research Institute, Barcelona, Spain.
authors.forename: Andrea Buron
authors.initials: AB
authors.lastname: Pust
authors.affiliation: Department of Obstetrics and Gynecology, Igualada Hospital, Consorci Sanitari de l'Anoia,Igualada, Barcelona, Spain.
authors.forename: Gemma Escribano
authors.initials: GE
authors.lastname: Montesdeoca
authors.affiliation: Department of Obstetrics and Gynecology, Igualada Hospital, Consorci Sanitari de l'Anoia,Igualada, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Guerra Garcia
authors.affiliation: Department of Obstetrics and Gynecology, Igualada Hospital, Consorci Sanitari de l'Anoia,Igualada, Barcelona, Spain.
authors.forename: Juan Carles Mateu
authors.initials: JC
authors.lastname: Pruñonosa
authors.affiliation: Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Spain.
authors.forename: Ramon Carreras
authors.initials: RC
authors.lastname: Collado
authors.affiliation: Department of Obstetrics and Gynecology, Igualada Hospital, Consorci Sanitari de l'Anoia,Igualada, Barcelona, Spain.
authors.forename: Pere Bresco
authors.initials: PB
authors.lastname: Torras
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D057186:Comparative Effectiveness Research; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004564:Electrocoagulation / Q000379:methods; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods; D007431:Intraoperative Complications / Q000175:diagnosis*; D008875:Middle Aged; D061646:Operative Time; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000175:diagnosis / Q000601:surgery
keywords: Ambulatory care hysteroscopy; Bipolar electrical resection; Diagnostic therapeutic hysteroscopy; Mechanical tissue removal system; TRUCLEAR System; VERSAPOINT