Extending cervicoplastic surgery: an alternative technique to overcome the limitation of office hysteroscopy

Dora Pavone,Flavia Sorbi,Eleonora Castellacci,Valeria Dubini,Giovanna Giarrè,Stefano Calzolari,Karin Louise Andersson,Chiara Comito,Felice Petraglia

doi:10.1186/s10397-020-01076-1

Abstract

Our objective is to show a feasible approach to the hysteroscopic procedures when the cervical canal has a diameter smaller than the lesion. Our study is designed as a case series and illustration of the surgical hysteroscopic technique. A group of patients (n = 37) underwent office hysteroscopy in Regional Reference Center for Hysteroscopy Service at Palagi Hospital, Florence, Italy, to see and treat an endometrial polyp with unfavorable cervical conditions between January 2019 and December 2019. An office hysteroscopy in outpatient setting with vaginoscopic approach was performed in women with unfavorable cervical conditions. Fiber-based 3.5-mm hysteroscope, with 5F electrosurgery unit and 5F bipolar electrode, was used to perform the cervicoplasty in order to enlarge the cervical canal from internal to external os, following by the removal of the endometrial polyp with the excision of the base only without slicing. After 90 days, a follow-up hysteroscopy was performed. The procedure was performed successfully in 89.2% of patients.The surgical technique of cervicoplastic allows to perform an operative procedure without analgesia/sedation or anesthesia or blind cervical dilation, reducing the risk of complications and costs. Furthermore, cervicoplasty allowed the removal en bloc of the endocavitary lesion in all cases. At the follow-up hysteroscopy, the cervical passage was straight and smooth, without lesions repaired in all patients. Cervicoplasty is a technique which allows to perfume an ease and comfortable hysteroscopic procedure even in patients with unfavorable cervical canal. Due to the widening of the diameter of the cervical canal, intracavitary lesions are removed intact resulting in an optimal pathological evaluation.

Highlights

Hysteroscopic surgery is commonly used to manage and treat different gynecological pathologies
Data were collected from a group of women (n = 37) undergoing hysteroscopy with unfavorable cervical conditions, namely, a lesion bigger than the cervical diameter, a previous conization, or a stenotic or tortuous cervical canal
Localizing the internal os, a lateral cut was performed for all the length of the cervical canal until the external os

Summary

Introduction

Hysteroscopic surgery is commonly used to manage and treat different gynecological pathologies. Modern hysteroscopic technologies are available to combine the possibility to explore the uterine cavity and treat surgically the disease (“see-and-treat-approach”). In a series of 31,052 office hysteroscopies, Bettocchi et al identified cervical stenosis in 32.7% of cases, with a major prevalence in postmenopausal women (2020) 17:8 than in reproductive age women (70.1% vs 29.9%), being the combined stenosis of both external and internal cervical os the most common form [4]. The diameter of the cervical canal and the age of patients influence the perception of pain during the procedure, affecting feasibility and acceptability of the surgical technique [5, 6]. Cervical dilatation is the most used method to treat cervical stenosis by the use of Hegar uterine dilatator [7] in an inpatient setting and the use of anesthesia with consequences on patient outcomes and hospital costs

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