SURGICAL METHODS FOR ENDOMETRIAL POLYPECTOMY AND ASSOCIATED ENDOMETRIAL INJURY

Abstract

Intrauterine procedures have the potential for endometrial injury, possibly leading to formation of intrauterine adhesions and infertility. Methods for removal of endometrial abnormalities, such as endometrial polyps, have traditionally been performed with sharp curettage or hysteroscopic scissors, however, the use of hysteroscopic morcellators has become more common in recent years. It is unclear which method, if any, is associated with lower frequency of endometrial injury. Therefore the purpose of our study was to determine if the frequency of endometrial injury differs between methods for removal of endometrial polyps. Retrospective cohort study All pathology samples from polypectomy procedures performed between 2014 and 2019 on women ages 18-50 were included in the study. Because the myometrium is deep to the endometrium and is not itself a target of these procedures, the presence and proportion of myometrium on surgical pathology samples were used to indicate endometrial injury. Pathology samples were re-evaluated by a single, blinded pathologist to measure the primary outcome of presence and proportion of myometrium. Secondary outcomes included operative complications and mention of myometrium on the initial pathology report. Data were evaluated using chi square analysis. Interim analysis of 195 of the 473 (41%) pathology samples demonstrated increased reporting of myometrial tissue on initial surgical pathology with morcellator use (46% of morcellator pathology reports), in comparison to traditional D&C (8%), and hysteroscopic scissors (3%) (p < 0.01). However, blinded pathology review demonstrated no differences in the overall presence of myometrium, presence of isolated myometrium or the proportion of myometrial tissue noted. There was no difference noted in surgical complications between the various methods of polypectomy. Interim analysis demonstrated increased reporting of myometrial tissue on initial surgical pathology with hysteroscopic morcellator use, however, no difference was found in the presence or quantity of myometrium upon blinded re-evaluation of samples.