Acceptability of Endometrial Polyp Resection under Local Anaesthesia

A J Abeywardena,A Sivasuriam

doi:10.4038/sljog.v39i1.7806

Abstract

Introduction: New evidence is emerging to suggest that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is non-inferior to in patient polypectomy under general anaesthesia. However, evidence on its acceptability warrants further evaluation. Objective: To assess the patient’s acceptability of endometrial polyp resection under local anesthesia in an outpatient setting. Methodology : A prospective cohort study was carried out for three months on all patients who underwent this procedure under local anaesthesia in a secondary care unit in the United Kingdom. Intra-operative and post-operative acceptability was assessed by a standard questionnaire filled immediately after the procedure and before discharge on the first post-operative day. Results : Fifty patients underwent this procedure. The mean age was 56.48(range36-83). Complete resection of the polyps was achieved in 94% of the patients, while 6% had partial resection without total failure. Average, intra operative, immediate post operative and day 1 post operative pain scores were 2.38, 1.44 and 1.38 respectively and were in the mild category of the Discrete Quantitative Pain Verbal Rating Scale. Seventy eight percent of the patients were totally satisfied with the procedure while 14% and 8% were generally and fairly satisfied. None expressed that the procedure was unacceptable. Ninety four percent opted to recommend the procedure to a friend while 96% of patients expressed their willingness to undergo the procedure under local anesthesia, if they were to have another resection of the polyp. Conclusion: Outpatient hysteroscopic polyp resection by morcellation under local anesthesia is well tolerated and accepted by patients in an outpatient setting.

Highlights

New evidence is emerging to suggest that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is non-inferior to in patient polypectomy under general anaesthesia
Ninety four percent opted to recommend the procedure to a friend while 96% of patients expressed their willingness to undergo the procedure under local anesthesia, if they were to have another resection of the polyp
New evidence suggests that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is noninferior to in patient polypectomy under general anaesthesia . [5,6,7] This has the added advantage of treating the patient at the time of diagnosis with many clinical and nonclinical benefits such as possibility of obtaining targeted tissue biopsies, avoidance of risk of general anaesthesia, low procedure related cost, less hospital appointments, least time away from home and quicker return to work . [9,10,11,12,13]

Summary

Introduction

New evidence is emerging to suggest that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is non-inferior to in patient polypectomy under general anaesthesia. Endometrial polyps are defined as localised hyperplasic overgrowths of the endometrial glands and stroma projecting from the surface of the endometrium. They accounts for 24 to 41 % of abnormal uterine bleeding according to various population studies . Polyp removal under general anaesthesia is offered to patients who are diagnosed with endometrial polyps. New evidence suggests that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is noninferior to in patient polypectomy under general anaesthesia . New evidence suggests that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is noninferior to in patient polypectomy under general anaesthesia . [5,6,7] This has the added advantage of treating the patient at the time of diagnosis with many clinical and nonclinical benefits such as possibility of obtaining targeted tissue biopsies, avoidance of risk of general anaesthesia, low procedure related cost, less hospital appointments, least time away from home and quicker return to work . [9,10,11,12,13]

Results

Discussion

Conclusion