Hysteroscopic Endometrial Polypectomy Research Articles

The efficacy of levonorgestrelintrauterine system, drospirenone & ethinylestradiol tablets (II) and dydrogesterone in preventing the recurrence of endometrial polyps.

To analyze the efficacy of levonorgestrelintrauterine system, Drospirenone & ethinylestradiol tablets (II), and dydrogesterone in preventing the recurrence of endometrial polyps after hysteroscopic endometrial polypectomy. One hundred seventy patients who underwent hysteroscopic endometrial polypectomy in the Gynecology Department of Tianmen First People's Hospital in Hubei Province from January 2022 to June 2023 were randomly divided into the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, dydrogesterone group, and a control group. The recurrence rates, endometrial thickness, and menstrual volume changes at 6 and 12months post-operation were compared among these four groups. The recurrence rates in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group were lower than the control group, with statistical significance (P < 0.01), with the levonorgestrelintrauterine system group having the lowest recurrence rate. The endometrial thickness at 6 and 12months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was thinner than that of the control group and thinner than pre-operation, with statistical significance (P < 0.01). The menstrual volume at 3months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was significantly less than the control group, and less than the pre-operation volume. Dydrogesterone, drospirenone & ethinylestradiol tablets (II), and levonorgestrelintrauterine system all play a role in preventing the recurrence of endometrial polyps, but levonorgestrelintrauterine system is significantly better than dydrogesterone and Drospirenone & ethinylestradiol tablets (II) in terms of postoperative recurrence rate, endometrial thickness, menstrual changes, and compliance, and is worth promoting in clinical application.

Case report: septic shock after endometrial polypectomy with tissue removal system

As an emerging surgical technology, tissue removal systems have been widely used in the treatment of endometrial polyps due to its characteristics of less endometrial damage, shorter learning curve and clearer vision of the operative field. There are few cases in the literature reporting serious complications after endometrial polypectomy using tissue removal systems. As known, septic shock is a rare complication following hysteroscopic polypectomy. Now, we present the case of a 23-year-old woman who developed septic shock after polypectomy with tissue removal system. The patient had a history of recurrent vaginitis for more than half a year. Due to endometrial polyps, she was admitted to our hospital and scheduled to undergo hysteroscopic endometrial polypectomy. Three hours after the endometrial polypectomy using the tissue removal system, the patient had shock symptoms such as increased body temperature, decreased blood pressure and increased heart rate. Then, the patient was successfully treated and discharged after anti-infection and anti-shock treatments. The purpose of this case report is to remind clinicians to consider the possibility of serious infection and comprehensively evaluate the risk of infection before choosing hysteroscopic devices for endometrial polyps, especially for patients who choose the mechanical hysteroscopic tissue removal systems. Furthermore, the mechanical hysteroscopic tissue removal systems should be used with caution in patients with previous recurrent vaginitis.

Pregnancy Rates after Hysteroscopic Endometrial Polypectomy versus Endometrial Curettage Polypectomy: A Retrospective Study.

Background and Objectives: A relationship between endometrial polypectomy and in vitro fertilization (IVF) pregnancy outcomes has been reported; however, only a few studies have compared polyp removal techniques and pregnancy rates. We investigated whether different polypectomy techniques with endometrial curettage and hysteroscopic polypectomy for endometrial polyps affect subsequent pregnancy outcomes. Materials and Methods: Data from 434 patients who had undergone polypectomy for suspected endometrial polyps using transvaginal ultrasonography before embryo transfer in IVF at four institutions between January 2017 and December 2020 were retrospectively analyzed. Overall, there were 157 and 277 patients in the hysteroscopic (mean age: 35.0 years) and curettage (mean age: 37.3 years) groups, respectively. Single-blastocyst transfer cases were selected from both groups and age-matched to unify background factors. Results: In the single-blastocyst transfer cases, 148 (mean age: 35.0 years) and 196 (mean age: 35.9 years) were in the hysteroscopic and curettage groups, respectively, with the 148 cases matched by age. In these cases, the pregnancy rates for the first embryo transfer were 68.2% (odds ratio (OR): 2.14) and 51.4% (OR: 1.06) in the hysteroscopic and curettage groups, respectively; the resulting OR was 2.03. The pregnancy rates after up to the second transfer were 80.4% (OR: 4.10) and 68.2% (OR: 2.14) in the hysteroscopic and curettage groups, respectively, in which the OR was 1.91. The live birth rates were 66.2% (OR: 1.956) and 53.4% (OR: 1.15) in the hysteroscopic and curettage groups, respectively, in which the odds ratio was 1.71. These results show the effectiveness of hysteroscopic endometrial polypectomy compared to polypectomy with endometrial curettage. No significant difference was found regarding the miscarriage rates between the two groups. Conclusions: Hysteroscopic endometrial polypectomy resulted in a higher pregnancy rate in subsequent embryo transfer than polypectomy with endometrial curettage. Therefore, establishing a facility where polypectomy can be performed hysteroscopically is crucial.

Outpatient Hysteroscopic Polypectomy—A Retrospective Study Comparing Rigid and Semirigid Office Hysteroscopes

Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients' pain perception during an operative hysteroscopic endometrial polypectomy in an outpatient setting with two different hysteroscopes (rigid and semirigid) and to identify some clinical and intraoperative characteristics that are related to worsening pain during the procedure. We included women that underwent, at the same time as an diagnostic hysteroscopy, the complete removal of an endometrial polyp (using the see-and-treat strategy) without any kind of analgesia. A total of 166 patients were enrolled, of which 102 patients underwent a polypectomy with a semirigid hysteroscope and 64 patients underwent the procedure with a rigid hysteroscope. No differences were found during the diagnostic step; on the contrary, after the operative procedure, a statistically significant greater degree of pain was reported when the semirigid hysteroscope was used. Cervical stenosis and menopausal status were risk factors for pain both in the diagnostic step and in the operative one. Our results confirm that operative hysteroscopic endometrial polypectomy in an outpatient setting is an effective, safe, and well-tolerated procedure and indicate that it might be better tolerated if a rigid rather than semirigid instrument is used.

Evaluation of the Clinical Effect in Hysteroscopic Endometrial Polypectomy

Evaluation of the Clinical Effect in Hysteroscopic Endometrial Polypectomy

Analysis of risk factors and model establishment of recurrence after endometrial polypectomy.

Currently, determining the postoperative recurrence of endometrial polyps is an unresolved issue, so we screened the risk factors to establish a nomogram for clinical practice. From January 2012 to June 2020, 133 patients who underwent hysteroscopic endometrial polypectomy and diagnostic curettage due to suspicious endometrial polyps for the first time and were pathologically diagnosed as endometrial polyps after surgery. All patients were followed up for more than 12 months, and 9 (6.77%) cases were lost to follow-up. Logistic regression analysis of clinical factors was performed to screen independent risk factors and construct a column chart to predict the probability of adverse events. The fitting curve was used to validate the line graph. The ratio of patients with body mass index (BMI) <28 kg/m2 in the recurrence group was lower than in the non-recurrence group (P=0.028), as was the proportion of patients with polyp <2 cm (recurrence group vs. non-recurrence group, P=0.027) and the proportion of patients in the recurrence group treated with progesterone after surgery compared with non-recurrence group (P=0.003). However, the proportion of endometrial thickening in the recurrence group was higher than in the non-recurrence group (P=0.006). Age, BMI, polyp size, and endometrial thickening were independent risk factors for recurrence after endometrial polypectomy [odds ratio (OR) >1, P<0.05]. Progesterone therapy after surgery was an independent protective factor for recurrence after endometrial polypectomy (OR <1, P<0.05). Our nomogram was based on age, BMI, polyp size, endometrial thickening, and postoperative progesterone treatment. The maximum offset between the predicted curve and the ideal curve was 0.083, and the minimum offset between the model and the ideal model was 0.021. The height of the linear curve was close to that of the ideal curve. The U test showed P=0.898, greater than 0.05, indicating that the nomogram model passed the calibration test. The receiver operating characteristic curve was 0.886. Our nomogram based on age, BMI, polyp size, progesterone treatment, and endometrial thickening accurately predicted the risk of polyp recurrence after endometrial polypectomy and can be applied in clinical practice.

Hysteroscopic endometrial polypectomy in postmenopausal women

Hysteroscopic endometrial polypectomy in postmenopausal women

Comparison of endometrial polyp recurrence in fertile women after office hysteroscopic endometrial polypectomy using two widely spread techniques.

To compare the recurrence of benign endometrial polyps after office hysteroscopic polypectomy performed with a bipolar electrode (BE) or a small diameter hysteroscopic tissue removal system (HTRs). From July 2018 to December 2019 we evaluated the charts of 114 asymptomatic fertile women who underwent office hysteroscopic polypectomy, 1 year before, for a single large benign endometrial polyp (size between 10 and 20 mm) using a 4 mm continuous flow hysteroscope with a BE or a 5 mm HTRs. Patients, divided into two groups according to surgical procedure, each performed exclusively by one expert gynecologist, were scheduled for a 12-month postoperative transvaginal sonography to evaluate the recurrence of endometrial polyps. Forty-eight women of the BE group and 42 of the HTRs group were considered for the 1-year transvaginal sonography follow-up. Five polyps were identified in the BE group and three in the HTRs group (5/48 vs 3/42, P = n.s.). All polyps were removed hysteroscopically (in three out of five and in two out of three cases, respectively, in the same places of the previous polypectomy) and evaluated as 'benign' by the pathologist. Office hysteroscopic endometrial polypectomy with small HTRs compared to BE revealed at a 1-year follow-up no difference in terms of complete removal and recurrence of polyps. HTRs polypectomy resulted in less pain and significantly quicker time of procedure compared to BE. This data should be kept in mind for patient comfort any time hysteroscopic polypectomy is planned in an office setting.

Office hysteroscopic endometrial polypectomy in premenopausal women at Zagazig University Hospitals: Traditional versus vaginoscopic approach

Background: Endometrial polyps are a main cause of Abnormal Uterine Bleeding (AUB) in premenopausal & postmenopausal women and suggested by screening transvaginal ultrasound. Objectives: The aim of the current study was to determine the effectiveness and acceptability of outpatient hysteroscopic endometrial polypectomy by vaginoscopic approach, and if the technique confers any advantage in term of patient discomfort and reduction in procedure time over the traditional technique. Patients & Methods: This study is prospective randomized clinical trial, it was carried in Endoscopy Unit in the Department of Obstetrics and Gynecology at Zagazig University Hospitals, in period from May 2018 to April 2019. Results: there was a statistical significant difference between traditional and vaginoscopic groups in procedure time where traditional technique needs more time than vaginoscopic one (7.8 VS 6.1 minutes), and all cases had (100.0%) success rate of polypectomy in both groups without complication. but histopathology results discovered one case (2.5%) of all study groups adenocarcinoma and the patient sent to oncology unit for further evaluation and appropriate management. Conclusions: Office vaginoscopic polypectomy for small polyp is feasible and safe minimally invasive procedure.

Benign Endometrial Polyp Recurrence after Office Hysteroscopic Polypectomy According to Surgical Procedure

Study Objective To compare the recurrence of benign endometrial polyps after hysteroscopic polypectomy performed with bipolar electrode (BE) or a small diameter hysteroscopic tissue removal system (HTRs). Design Prospective randomized study approved by the Institutional Review Board. Setting University-Hospital. Patients or Participants From January to December 2017, 93 of 120 fertile women, with a single endometrial polyp (between 10 and 20 mm) accepted to participate in the study and were randomized into two groups according to the type of surgical procedure assigned them by “QuickCalcs” of “Graphpad Software”. Only women with removed polyps, classified as “benign” after pathological assessment, were considered. Interventions A 4mm hysteroscope (Karl Storz, Germany) with BE (Versapoint, Gynecare) was used for 51 women (BE Group). The 5mm HTRs (TruClear 5C System, Medtronic, Ireland) was used for 42 patients (TruClear Group). All hysteroscopic polypectomies were performed in an office setting with the vaginoscopic approach during the early proliferative phase. Patients were scheduled for a 12-month postoperative transvaginal ultrasound evaluation. Measurements and Main Results Polyps were completely removed in 48 out of 51 (94.12%) BE group and in 40 out of 42 HTR group (95.24%). The median time for polypectomy was significantly lower for HTR group (3.6 ± 1.7 minutes) compare to 8.7 ± 2.8 minutes for the BE Group, p Conclusion In this prospective randomized study, hysteroscopic endometrial polypectomy resulted significantly quicker with small HTRs compared to BE without differences in terms of complete removal and recurrence of polyps.

2021 Hysteroscopic Polypectomy with Stone Retrieval Basket

Video Objective To present an alternative approach to hysteroscopic endometrial polypectomy. Currently most hysteroscopic polypectomy procedures are performed using a single use instruments such as a bipolar resectoscope or one of the several commercially available hysteroscopic morcellation devices. This surgical procedure allows the completion of a hysteroscopic polypectomy without incurring the costs associated with these single use instruments. Setting A 70-year-old female with post-menopausal bleeding and an ultrasound finding concerning for an endometrial polyp. Interventions Hysteroscopic removal of an endometrial polyp with a urologic stone retrieval basket. Conclusion The utilization of a stone retrieval basket is a novel and effective method for retrieving a wide based endometrial polyp following incomplete resection with hysteroscopic scissors.

Effect of Shengxuening tablets combined with ethinylestradiol and cyproterone acetate on thickness of endometrium and hemoglobin levels in patients with endometrial polyps for transcervical resection of polyp

Objective To investigate the effects of Shengxuening tablets combined with ethinylestradiol and cycloproterone acetate on endometrial thickness and hemoglobin level in patients with endometrial polyps for transcervical resection of polyp. Methods A total of 150 patients with hysteroscopic endometrial polypectomy were randomly divided into three groups, 50 in each group. The control group was treated with hysteroscopy endometrial polyp electrotomy, while the western medicine group was treated with ethinylestradiol and cycloprogesterone acetate tablets on the basis of the control group, and the combined group was treated with Shengxuening tablets on the basis of the western medicine group. The menstrual volume, endometrial thickness and hemoglobin levels were observed before treatment, at 3 month, 6 month and 12 month after treatment, and the clinical efficacy and recurrence during follow-up were evaluated. Results The total effective rate was 98.0% (49/50) in the combined group, 96.0% (48/50) in the western medicine group, 86.0% (43/50) in the control group. The total effective rate in the combined group and the western medicine group was significantly higher than that in the control group (χ2=6.643, P=0.036). The menstrual volume (F=28.096, 49.096, 33.303), endometrial thickness (F=11.214, 20.265, 63.947) in the three groups were significantly different after treatment (P<0.01), and which in the combined group were significantly lower than those in the western medicine group, menstrual volume at 3 6,12 after treatment (t value were 4.747, 2.244, 4.489, P<0.01); endometrial thickness at 3, 6, 12 month after treatment (t value were 3.293, 3.356, 5.293, P<0.01); there were significant differences in hemoglobin levels in the three groups (F=11.002, 8.662, 8.958, P<0.01), and which in the combined group was significantly higher than that in the western medicine group at 3,6,12 month after treatment (t value were 2.722, 2.074, 2.028, P<0.05). During the follow-up period, 2 cases (4.1%) recurred in the combined group, 3 cases (6.3%) recurred in the western medicine group and 9 cases (20.9%) recurred in the control group. The recurrence rate in the combined group or the western medicine group was significantly lower than that in the control group (χ2=6.775, P=0.034). There was no significant difference in the recurrence rate in the combined group and the western medicine group (χ2=0.211, P=0.646). Conclusions The Ethynestradiol and Cyproterone acetate combined with Shengxuening tablets could improve the curative effect, reduce menstrual volume and endometrial thickness, increase hemoglobin level and reduce recurrence rate in patients with endometrial polyps for transcervical resection of polyp. Key words: Endometrial hyperplasia; Endometrial ablation techniques; Hysteroscopes; Hemoglobinometry; Ethinylestradiol and cyproterone acetate tablets; Shengxuening tablets

Hysteroscopic Endometrial Polypectomy with Manual Vacuum Aspiration Compared to Mechanical Morcellation

To examine the effectiveness of hysteroscopy plus manual vacuum aspiration (MVA) for endometrial polypectomy compared with hysteroscopic morcellation. Retrospective cohort study (Canadian Task Force classification II-2). Duke University Medical Center database. Women who underwent hysteroscopic removal of endometrial polyps performed by Duke Fertility Center faculty physicians between January 1, 2015, and January 29, 2018, using either hysteroscopy plus MVA or hysteroscopic morcellation. The 2 groups were compared using the χ2 or Fisher's exact test, Student's t test, and multivariable regression analysis. The primary outcome was the duration of the procedure. Secondary outcomes were fluid deficit, rate of complete polyp resection, estimated blood loss, and operative complications. A total of 102 women undergoing endometrial polypectomy were identified. Patients in whom polyps were removed using only a hysteroscopic grasper and/or scissors (n = 31); patients who underwent an additional simultaneous procedure, such as laparoscopy (n = 12); and patients in whom the duration of the procedure was not recorded (n = 2) were excluded. Among the remaining 57 patients, 28 underwent hysteroscopy plus MVA and 29 underwent hysteroscopic morcellation. The mean duration of procedure was longer for hysteroscopic morcellation compared with hysteroscopy plus MVA (32 ± 10 minutes vs 20 ± 6 minutes; p = .04), and this difference remained significant after adjusting for age, body mass index, surgeon, and number and size of polyps. Mean fluid deficit was greater for morcellation than for hysteroscopy plus MVA (277 ± 204 mL vs 51 ± 97 mL; p < .001). Complete polyp resection was possible in all patients; however, the use of a hysteroscopic scissors and grasper was required for 1 patient in the MVA group. Estimated blood loss was minimal in all cases, and there were no operative complications. Hysteroscopy plus MVA is an effective method for removing large or multiple endometrial polyps, with outcomes comparable to hysteroscopic morcellation.

High number of endometrial polyps is a strong predictor of recurrence: findings of a prospective cohort study in reproductive-age women

To compare the incidence of recurrence between a cohort with a high number (≥6) of endometrial polyps (EPs) and a single-EP cohort among reproductive-age patients after polypectomy. Prospective observational cohort study. Single university center. Premenopausal women who underwent hysteroscopic endometrial polypectomy were recruited. Patients underwent a transvaginal ultrasound scan every 3months after polypectomy to detect EP recurrence. Kaplan-Meier and Cox regression models were used to compare the risk of recurrence between the two cohorts and analyze the potential risk factors for EP recurrence. EP recurrence rate. The study enrolled 101 cases with a high number of EP and 81 cases with a single EP. All baseline parameters were similar except that the high number of EP cohort had a slightly lower mean age than the single EP cohort (33.5 [range 30.0-39.0] vs. 36.0 [30.5-43.0] years). The risk of recurrence in the high number of EP cohort was 4.08 (95% confidence interval [CI] 1.89-8.81) times higher than that in the single-EP cohort 1year after polypectomy, with a recurrence rate of 45.5% versus 13.4%, respectively. A high number of EPs, endometriosis, and previous polypectomy history were independently associated with polyp recurrence. The high number of EP cohort was much more prone to recurrence than the single-EP cohort. A high number of EPs, endometriosis, and previous polypectomy history were independent risk factors for recurrence. A high number of EPs is suggested to be a distinct subgroup with different pathogenesis, which warrants frequent monitoring and prevention.

Frequency of endometrial cancer and atypical hyperplasia in infertile women undergoing hysteroscopic polypectomy.

We aimed to determine the frequency of endometrial cancer in infertile women undergoing hysteroscopic endometrial polypectomy for endometrial polyps. A total of 1035 infertile patients who underwent office-based hysteroscopic polypectomy at Sugiyama Clinic Marunouchi between July 2011 and October 2015 were eligible for this retrospective study. All patients had been diagnosed with endometrial polyps via hysterofiberscopy prior to operation, and they underwent hysteroscopic endometrial polypectomy using a resectoscope with monopolar resection. Surgical specimens were examined histopathologically. Characteristics of patients diagnosed with endometrial cancer on histopathological examination were evaluated retrospectively. The median age of patients was 32years (range, 19-44years). On histopathological examination, endometrial cancer was found in 10 patients (0.97%). Each histological type of endometrial cancer was represented as follows: three cases of endometrioid adenocarcinoma G1; one of endometrioid adenocarcinoma G2; two of endometrioid adenocarcinoma G3; and four of atypical endometrial hyperplasia. The median age of endometrial cancer patients was 34years (range, 28-41years), and the median body mass index was 21.2kg/m2 (range, 16.7-29.9kg/m2 ). Nine endometrial cancer patients were nulliparous, and all had undergone infertility treatment, with only one woman having delivered a healthy baby. An ovulation disorder was noted in four patients, with obesity (body mass index>25kg/m2 ) in just two. Polycystic ovary syndrome was concomitantly observed in one patient. However, abnormal vaginal bleeding was not noted in any of these patients. Hysteroscopic polypectomy should be performed when endometrial polyps are detected on investigational screening, and surgical specimens should be checked for the presence of malignancy.

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外来における麻酔および頸管拡張が不要な子宮鏡下子宮内膜ポリープ除去術―LINスネア&lt;sup&gt;®&lt;/sup&gt;の有用性について―

Feasibility of hysteroscopic endometrial polypectomy using a new dual wavelengths laser system (DWLS): preliminary results of a pilot study.

Currently, endometrial polyps may be successfully treated in an outpatient setting with 5 Fr mechanical and bipolar instruments. Our aim is to evaluate the benefits of minimally invasive techniques in hysteroscopy, focusing on the use of a new dual wavelengths laser system in the treatment of endometrial polyps in an outpatient setting. Between September 2012 and December 2014, all consecutive patients of reproductive and menopausal age with ultrasound diagnosis of endometrial polyp with maximum diameter ≤2.5cm were eligible to participate in a prospective study. They underwent a hysteroscopic procedure with excision of the polyp using a new dual wavelengths laser system. All procedures were performed on an outpatient basis without anesthesia. Laser polypectomy was successfully performed in 219 out of 225 (97.3%). Success of surgery was not influenced by the initial location of polyp. No main complications were reported during or immediately after the procedure. 6 and 12months follow-up with ultrasound scan did not show any persistence or recurrence of the pathology. Our preliminary findings seem to support the safety and the effectiveness of the laser hysteroscopic endometrial polypectomy. However, further studies are mandatory to validate its use in daily hysteroscopic practice.

Fertility-sparing management combined with photodynamic therapy for endometrial stromal sarcoma: A case report

Low-grade endometrial sarcoma (LGESS) has a favorable prognosis after standard surgical treatment. The conservative fertility-sparing treatments in young patients with LGESS have been reported; however, the role of conservative therapy is not well defined. A 31-year-old nulliparous woman was diagnosed with LGESS after resection of a cervical polyp with resection margin positive for malignancy. She underwent fertility-sparing surgery including laparoscopic pelvic lymph node dissection, hysteroscopic endometrial polypectomy, endocervical curettage, and photodynamic therapy (PDT) on the endometrium and uterine cervix. And she had received adjuvant therapy with a non-steroidal aromatase inhibitor. She conceived by in vitro fertilization and delivered twins at 32+2 weeks gestation by Cesarean section 32 months after conservative treatment. She has no evidence of recurrence after 99 months of follow-up. Conservative management of LGESS may be attempted in selected patients who want to preserve fertility. Conservative surgery combined with PDT has shown effective results in long-term follow-up.

Learning Curve and Feasibility of Hysteroscopic Endometrial Polypectomy in the Office Setting: Results of the Initial Sample of Sixty Patients

Learning Curve and Feasibility of Hysteroscopic Endometrial Polypectomy in the Office Setting: Results of the Initial Sample of Sixty Patients

39: Endometrial Polyps: Elusive Yet Manageable

To determine clinical outcomes, histological findings, and effectiveness of hysteroscopic endometrial polypectomy without endometrial ablation in women with endometrial polyps. The effectiveness of operative hysteroscopic polypectomy for the treatment of abnormal uterine bleeding, patient satisfaction, and long-term follow-up were assessed.