Outpatient Hysteroscopic Polypectomy in Postmenopausal Women: A Comparison between Mechanical and Electrosurgical Resection

Abstract

Study Objective Comparison of operating outcomes of office hysteroscopic polypectomy accomplished by mechanical or bipolar electrosurgical instrumentation. Design Prospective study (Canadian Task Force classification II-1). Setting Public hospital. Patients A total of 101 consecutive postmenopausal patients showing, during office hysteroscopy, 1 or more endometrial polyps measuring more than .5 cm. Interventions Hysteroscopy was carried out with a 2.9-mm optic and a 3.9- × 5.9-mm sheathed operative hysteroscope, without local anesthesia or systemic analgesia. The diagnostic phase was immediately followed by polyp resection, alternatively allocating the patients to mechanical or electrosurgical polypectomy. Hysteroscopic scissors were used for mechanical polypectomy, whereas 5F coaxial bipolar twizzle electrodes were used for electrosurgical polypectomy. Measurements and Main Results Effectiveness of polypectomy, operation time, and evaluation of induced pelvic pain (scored on a 1–10 cm visual analog scale), were the end points of comparison between the 2 techniques. Nine patients were excluded because of severe pelvic pain arising in the diagnostic phase or the finding of an oversize polyp requiring an estimated time of more than 30 minutes to be removed in the office setting. Of the remaining 92 patients, 46 underwent mechanical and 46 electrosurgical polypectomy. Clinical variables (i.e., age, age at menopause, parity, polyp size, and number) were similar in the 2 study arms. Polypectomy was accomplished in 79 (85.8%) of 92 patients. Among the considered clinical variables, effectiveness of resection was significantly related to age of patients (p = .04) and polyp size (p = .004). Mechanical and electrosurgical polypectomy was completed in 37 (80.4%) of 46 patients and in 42 (91.3%) of 46 patients, respectively (p = .13). Furthermore, mechanical and electrosurgical resections did not significantly differ as regards median surgical time (15.0 min [range 5–45] and 15.5 min [range 8–40], respectively; p = .53) and visual analog scale scores (3.7 ± 2.5 and 3.2 ± 1.9, respectively; p = .48). No major complications were recorded. Atypical polyp histology occurred in 9 (8.8%) patients, 5 of whom were asymptomatic. Conclusion Outpatient see-and-treat polypectomy represents a safe and effective alternative to resectoscopic polypectomy, leading to a complete polyp excision in about 80% of postmenopausal patients. No differences in the rate of polyp excision, surgical time, or induced pelvic discomfort were observed between electrosurgical and mechanical techniques.