Hysteroscopic Polypectomy Research Articles

Hysteroscopy as a Primary Tool in Exploration and Treatment of Infertility: Single Center Experience in Western Romania.

(1) Background: Infertility is a disease that affects millions of individuals worldwide. Intrauterine lesions are common in infertile women, hysteroscopy being considered the gold standard for assessing them, even if in routine clinical practice indirect imaging techniques are the first-line investigative tools. The aim of the study was to evaluate hysteroscopic findings among women with unexplained infertility and to analyze fertility outcomes after operative hysteroscopy; (2) Methods: a retrospective cohort study was conducted among 198 women with infertility that had undergone hysteroscopy as the first step of their infertility workup. (3) Results: The median age of the participants was 34 years, 67.7% of them being diagnosed with primary infertility. The most common abnormalities were endometrial polyps, uterine synechiae and uterine fibroids. In addition, pregnancy rates were 23.1% after hysteroscopic polypectomy, 11.1% after hysteroscopic myomectomy and 23.8% after uterine synechiae resection; (4) Conclusions: Endometrial polyps were the most common uterine abnormality found in women with infertility. Hysteroscopic interventions appeared to increase pregnancy rates and outcomes among these women.

Outcomes Using Hysteroscopic Morcellator for Evacuating Products of Conception after Missed Abortion

Study Objective To determine whether hysteroscopic morcellation is safe and effective in evacuating missed abortions. Design Retrospective review of Prospectively Maintained Database. Setting Office and operating room (OR). Patients or Participants Women undergoing hysteroscopic morcellation to treat missed abortion (<12 weeks) from May 2019 through February 2021. Interventions Hysteroscopic evacuation of products with chromosomal analysis. Post-operative evaluation of uterine cavity with saline-infused sonohysterogram (SIS). Measurements and Main Results Forty-five (45) patients underwent hysteroscopic morcellation. The mean age was 35.6 years (range 26- 48 years), mean gravida 2.09 (range 1- 8) and mean parity of 0.57 (range 0-6). Sixty two percent (28) were performed in the office under sedation, while thirty eight percent (17) were performed in OR. The mean gestational age was 8 1/7 days (range 5- 11 weeks) with a mean B-hcg of 31,311 (range 1100-149,983). Thirty-one (68.9%) had never undergone an intra-uterine procedure, 6 (13.3%) had a previous suction D&C, 6 (13.3%) had a previous diagnostic hysteroscopy, and 9% had a previous operative hysteroscopy (including 2 patients with more than 1 procedure). Only 3 (6.6%) patients experienced a complication during the procedure and none experienced a post-operative complication. All complications were due to excess fluid absorption (two were given intravenous diuretics and one recovered without intervention). In terms of chromosomal analysis, 21 (46.7%) had a normal karyotype, 18 (40%) had an abnormal karyotype, and 6 (13.3%) had no growth of chromosomes. Thirty-five (77%) patients had a normal SIS within 3 months. Two had abnormal findings on SIS. One underwent hysteroscopic polypectomy and the second underwent hysteroscopy for suspected retained products, but the hysteroscopy was normal. Eight (17.7%) did not undergo SIS, but three were subsequently pregnant. Conclusion Hysteroscopic morcellation is safe and effective for treating first trimester miscarriages with a low complication rate, strong ability to evaluate the tissue for chromosomal analysis, and no evidence of intrauterine adhesions post-operatively. To determine whether hysteroscopic morcellation is safe and effective in evacuating missed abortions. Retrospective review of Prospectively Maintained Database. Office and operating room (OR). Women undergoing hysteroscopic morcellation to treat missed abortion (<12 weeks) from May 2019 through February 2021. Hysteroscopic evacuation of products with chromosomal analysis. Post-operative evaluation of uterine cavity with saline-infused sonohysterogram (SIS). Forty-five (45) patients underwent hysteroscopic morcellation. The mean age was 35.6 years (range 26- 48 years), mean gravida 2.09 (range 1- 8) and mean parity of 0.57 (range 0-6). Sixty two percent (28) were performed in the office under sedation, while thirty eight percent (17) were performed in OR. The mean gestational age was 8 1/7 days (range 5- 11 weeks) with a mean B-hcg of 31,311 (range 1100-149,983). Thirty-one (68.9%) had never undergone an intra-uterine procedure, 6 (13.3%) had a previous suction D&C, 6 (13.3%) had a previous diagnostic hysteroscopy, and 9% had a previous operative hysteroscopy (including 2 patients with more than 1 procedure). Only 3 (6.6%) patients experienced a complication during the procedure and none experienced a post-operative complication. All complications were due to excess fluid absorption (two were given intravenous diuretics and one recovered without intervention). In terms of chromosomal analysis, 21 (46.7%) had a normal karyotype, 18 (40%) had an abnormal karyotype, and 6 (13.3%) had no growth of chromosomes. Thirty-five (77%) patients had a normal SIS within 3 months. Two had abnormal findings on SIS. One underwent hysteroscopic polypectomy and the second underwent hysteroscopy for suspected retained products, but the hysteroscopy was normal. Eight (17.7%) did not undergo SIS, but three were subsequently pregnant. Hysteroscopic morcellation is safe and effective for treating first trimester miscarriages with a low complication rate, strong ability to evaluate the tissue for chromosomal analysis, and no evidence of intrauterine adhesions post-operatively.

IMMEDIATE START IVF STIMULATION FOLLOWING POLYPECTOMY DOES NOT IMPACT PREGNANCY OUTCOMES IN LARGE MULTICENTER COHORT OF OVER SIXTEEN HUNDRED EMBRYO TRANSFERS

To determine if delayed IVF stimulation start after hysteroscopic polypectomy (HP) has superior pregnancy outcomes when compared to an immediate start in both fresh and frozen embryo transfers (FET). We analyzed IVF cycles following HP from 2017 - 2021 at a large multicenter private practice. Cohorts of fresh and frozen embryo transfers performed after HP were identified using standard CBT codes. These cohorts were divided into 3 groups consistent with prior studies according to time to embryo transfer at intervals of: within 28 days, 28-90 days, and 28-180 days for both fresh and FET. The interval “within 28 days” represented “immediate IVF stimulation start.” All other time intervals were compared to the “immediate start” group. To identify significant differences between groups, chi square analysis and linear regression were utilized to compare between groups with p values <0.05 for significance. Lastly, a continuous analysis of the number of days from HP to ET compared with live birth was made utilizing GEE analysis for all transfers. A total of 1619 cases were identified as undergoing frozen or fresh embryo transfers following HP, including 488 fresh and 1131 FET. Controlling for age, BMI, and PGT for aggregate FETs and fresh transfers, there was no difference in live birth when comparing the number of days from HP to ET (p= 0.984). Specifically, the time to embryo transfer was not associated with negative pregnancy outcomes from either fresh or FET, when comparing intervals of less than 28d, 28-90d and 28-180 days post HP; fresh (p= 0.14) or FET (p = 0.31). Pregnancy outcomes included not pregnant (NP), spontaneous abortion (SAB), ongoing pregnancy (ONG), stillbirth (SB), and live birth (LB). Delaying either fresh or frozen embryo transfer following HP does not significantly improve pregnancy outcomes.

Predictive factors of spontaneously regressed uterine endometrial polyps during the waiting period before hysteroscopic polypectomy

BackgroundThe presence of uterine endometrial polyps is associated with not only abnormal uterine bleeding but also infertility, so the use of hysteroscopic polypectomy has been increasing. This operation is considered to increase cost-effectiveness when performed prior to infertility treatments. However, there are typical problems to consider, including the possibility of spontaneous regression of the polyp and the duration of complete endometrial wound healing after surgery. Meaningless interventions must be avoided, when possible. Therefore, data acquisition and analysis of various findings obtained from surgery have become important for improving treatment procedures and patient selection. To estimate the spontaneous regression rates and contributions of multiple factors to uterine endometrial polyps during the waiting period (approximately 2–3 months) before hysteroscopic polypectomy, we performed a multivariate analysis of data from the records in our hospital.MethodsThe medical records of 450 cases from September 2014 to April 2021 in our hospital were retrospectively reviewed under the approval of our Institutional Review Board. We included all cases of hysteroscopic polypectomy with postoperative pathological diagnosis. We defined cases as having a “spontaneously regressed polyp” when the target polyp was not detected by postoperative pathological examination. We extracted data on the following ten factors: “Advanced age” (≥ 42 years), “Small polyp” (< 10 mm), “High body mass index” (≥ 25 kg/m2), “Nulliparity,” “Single polyp,” “Infertility,” “Hypermenorrhea,” “Abnormal bleeding,” “No symptom,” and “Hormonal drug use.” We also classified cases into five groups according to the size of the polyp (≤ 4.9 mm, 5.0–9.9 mm, 10.0–14.9 mm, 15.0–19.9 mm, and ≥ 20.0 mm) and determined the frequency of spontaneously regressed polyp in each group.ResultsAfter exclusion of cases with insufficient data or other diseases, such as submucosal leiomyoma, 424 cases were analyzed. Among them, 28 spontaneously regressed polyps were identified, and the highest frequency of spontaneously regressed polyp was detected among the cases with polyps measuring 5.0–9.9 mm (16.4%). On multivariate analysis of the ten factors, “Small polyp” and “Hormonal drug use” were found to significantly impact the frequency of spontaneously regressed polyp.ConclusionsOn the basis of the factors identified in this analysis, the indications for observation or medical therapy adapted to small polyps might be expanded.

Diagnosis of abnormal uterine bleeding using PALM COEIN classification and its management: An institutional experience

Aims: Categorization and treatment of abnormal uterine bleeding based on FIGO - PALM COEIN classification system&#x0D; Methods: A prospective cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru for a period of 1year from January 2019 to December 2019. All cases with abnormal uterine bleeding in 20 - 50 years of age were taken. Clinical details and imaging tests recorded, and categorized by FIGO- PALM COEIN classification for diagnosis and treatment. Statistical Package for Social Sciences version 21 was used to analyse the data and presented as frequencies and percentages.&#x0D; Results: Out of 300 women of AUB, 190 had structural (PALM) and 110 women had nonstructural (COEIN) aetiology; 138 women among 300 underwent hysterectomy and 20 patients underwent hysteroscopic polypectomy. Levonorgestrel intrauterine device inserted in 40 patients, 85 women were managed medically and 17 women lost to follow-up for further management.&#x0D; Conclusion: FIGO PALM-COEIN classification system for the diagnosis and treatment of abnormal uterine bleeding was adopted for the uniform standard.

Resectoscopic Surgery Part I: Overcoming Obstacles and Mastering the Basics

The introduction of the continuous flow gynecologic resectoscope (CFGR) in 1989 revolutionized minimally invasive gynecologic surgery (MIGS) by introducing such intrauterine procedures as hysteroscopic myomectomy, polypectomy, and endometrial ablation. However, with the subsequent introduction of global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs), the CFGR has fallen into relative disuse—a regrettable situation since it remains ideally suited for accomplishing many procedures that are otherwise not achievable with these newer technologies. Procedures which involve greater precision and control—endomyometrial resection (EMR), hysteroscopic metroplasty, the correction of isthmoceles, the resection of intramural myomas, and the management of late-onset endometrial ablation failure—are only possible with the CFGR. In addition, the CFGR permits a variety of functions that would otherwise require several different disposable platforms. Despite the benefits of the gynecologic resectoscope, there are clear impediments to its use including a scarcity of educational resources and trained experts, medico-legal concerns, institutional obstacles to organizing an operative team, and the need to develop and maintain an adequate caseload. In Part I of this three-part series, the author will review why the CFGR remains a relevant and indispensable tool for the minimally invasive gynecologic surgeon, the composition of an operating room team, and the instrumentation and skills necessary to accomplish basic resectoscopic surgery. In Part II, we will describe how ultrasound guidance can be used to assist the execution of more challenging intermediate-level cases. Finally, in Part III, we will discuss the most demanding cases for the resectoscopic surgeon—the treatment of post-ablation failures and the removal of intramural leiomyomas—which are clinical scenarios that require ultrasound guidance and well-honed resectoscopic surgical skills.

Prevalence and risk factors for malignancy in hysteroscopy-resected endometrial polyps.

To determine the prevalence of malignant lesions in endometrial polyps by hysteroscopic polypectomy, and risk factors for malignant transformation. The secondary aim was to evaluate background endometrium of atypical hyperplasia in endometrial polyps, and the risk of coexisting endometrial carcinoma after hysterectomy. This retrospective study included women who underwent hysteroscopic polypectomy between January 2015 and December 2019. Demographic characteristics, hysteroscopic findings, and histopathology results of the polyp and the uterus, in the case of a hysterectomy, were collected. In all, 946 women were included in the study. Endometrial carcinoma in a polyp was found in 10 women (1.06%), and atypical hyperplasia was found in 11 women (1.16%). At the multivariate logistic regression model of risk factors, old age (P=0.022) and obesity (P=0.011) were significantly associated with (pre-)malignant polyp. Five of the ten women (50%) with atypical hyperplasia confined to a polyp had coexisting endometrial carcinoma in the hysterectomy specimen. Women with risk factors should be offered hysteroscopic polypectomy to allow a reliable histologic evaluation. Furthermore, hysterectomy is recommended in women with atypical hyperplasia in endometrial polyps even after complete resection.

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps.

To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Removal of a Large Endometrial Polyp: Hysteroscopic Morcellation

Endometrial polyps (EPs) are usually benign lesions and can cause vaginal bleeding, infertility, and rarely uterine malignancy. The hysteroscopic polypectomy is the gold standard for the surgical treatment but especially in large polyps hysteroscopic removal systems (morcellator) can offer some surgical benefits. Hysteroscopic removal systems (morcellator) uses mechanical rotating energy system with simultaneous tissue cutting and aspirating. In this case, a large EP was removed by hysteroscopic morcellator completely. The operative time, fluid deficit and visualization were satisfying.

Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study.

The optimal timing of frozen-thawed blastocyst transfer following hysteroscopic polypectomy is an important and unanswered clinical question. In this study, we conducted a retrospective survey of cases from an infertility center at an academic hospital. We reviewed the charts of all patients who received in-vitro fertilization and frozen-thawed blastocyst transfers (FBT) at the center from January 2009 to November 2019. One hundred and two patients with prior diagnosis of endometrial polyp that were treated with hysteroscopic polypectomy before received their first FBT at the center were identified as cases. Patients without prior diagnosis of endometrial polyp, and who received their first FBT at the center were defined as controls. Controls were enrolled at a 1-to-1 ratio to the cases. The cases and controls did not show differences in baseline characteristics, endometrial thickness, or the number of good blastocysts transferred. The clinical pregnancy rates and live birth rates were similar. Regarding the optimal interval between polypectomy and FBT, a cut-off of 120 days was identified from the ROC curve. A stratified analysis showed that when FBT was performed within an interval of 120 days after polypectomy, there were higher biochemical pregnancy rates (73.2%, 45.2%; OR 3.3; P = .007) and clinical pregnancy rates (64.8%, 41.9%; OR 2.54; P = .032), when compared with intervals greater than 120 days. There were no significant differences in implantation and live birth rates. In conclusion, pregnancy rates following FBT in patients who had received prior endometrial polypectomy were comparable to pregnancy rates after FBT in patients without endometrial polyp. Subgroup analysis showed that an interval greater than 120 days between hysteroscopic polypectomy and FBT was associated with decreased pregnancy rates. Patients who wish to receive embryo transfer after polypectomy should wait no longer than 120 days.

Effectiveness of Hysteroscopic Morcellation of Endometrial Polyps Compared to Traditional Technique: A Comparison of Disease Recurrence

Study ObjectiveTo compare the outcomes between hysteroscopic morcellation of endometrial polyps and traditional techniques such as hysteroscopic resection with monopolar or bipolar radiofrequency energy, scissors and graspers or mechanical resection with polyp forceps.DesignRetrospective chart review.SettingAcademic tertiary referral center.Patients or Participants193 patients who underwent operative hysteroscopic polypectomy between January 2015 and May 2016.InterventionsHysteroscopic polypectomy with intrauterine morcellation, monopolar or bipolar radiofrequency energy, scissors and graspers or mechanical resection with polyp forceps with evaluation and/or treatment of recurrent abnormal uterine bleeding (AUB) after operative polypectomy.Measurements and Main ResultsThere were 9 patients who underwent hysteroscopic polypectomy with monopolar radiofrequency energy, 3 patients with bipolar radiofrequency energy, 91 patients with intrauterine morcellation, 67 patients with polyp forceps and 12 patients with scissors and graspers. The recurrence rate for AUB for monopolar was 1.89%, bipolar was 1.67%, intrauterine morcellation was 1.93%, polyp forceps was 1.84% and hysteroscopic scissors and/or graspers was 1.83%. Among the recurrences the average time until recurrence was 1162 days for monopolar, 207 days for bipolar, 749.5 days for intrauterine morcellation, 477.6 days for polyp forceps and 341.5 days for hysteroscopic scissors and graspers.ConclusionThere was no significant difference in terms of recurrence of AUB following the different modalities of operative hysteroscopy. Among the patients with recurrence in order of shortest time until recurrence: bipolar, hysteroscopic scissors and graspers, polyp forceps, intrauterine morcellation and monopolar.

The Novel Application of Transvaginal Notes for Hysteroscopic Polypectomy and Cervicalmyomectomy

Study Objective To demonstrate the advantages of using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for both hysteroscopic polypectomy and cervical myomectomy. Design Video presentation of the surgical procedure. Setting University hospital. Patients or Participants A sexually inactive patient with numerous comorbidities presented with irregular vaginal bleeding in the setting of worsening pelvic pain and bladder pressure for three year. Pelvic MRI showed multiple cervical fibroids and an endometrial polyp. Interventions After the patient was anesthetized, a narrow vagina with no visibility of the cervical os was detected. vNOTES hysteroscopic polypectomy and cervical myomectomy were determined to be more appropriate than conventional methods. A GelPOINT mini port was first placed in the vagina, which allowed for entrance into the uterine cavity. A Myosure hysteroscope and laparoscopic tenaculum were inserted through the port, and polyps in the uterine cavity were then removed. After polypectomy, a transverse incision was made on the anterior cervix through the same port for cervical myomectomy. The tenaculum was used to grab the fibroid and a harmonic scalpel was then applied for enucleation. V-loc was used to close the incision and reconstruct the cervical canal. After suturing, hysteroscopy was performed again to confirm normal anatomy. A Foley catheter was placed to prevent cervical stenosis. Measurements and Main Results Complete resection of cervical myoma and uterine polyp were performed, with postoperative relief of symptoms (i.e. bladder pressure). The surgery was 70 mins with Conclusion For patients with cervical polyps and/or myomas who cannot be operated by conventional methods, NOTES hysteroscopy and myomectomy may be an attractive option and lead to less surgical complications, reduced pain, and faster recovery.

Surgical simulation supplements reproductive endocrinology and infertility fellowship training

ObjectiveTo assess if a surgical boot camp improves laparoscopic skill among reproduction endocrinology and infertility (REI) fellows and increases fellow desire to incorporate surgical skills into practice and to examine whether fellowship in vitro fertilization (IVF) volume correlates with surgical efficiency.DesignProspective evaluation.SettingSimulation Center.Patient(s)Forty REI fellows.Intervention(s)Fellows were timed before and after training in laparoscopic suturing and knot tying and while using virtual simulators. Fellows were surveyed before boot camp on prior experience with IVF and reproductive surgery, and immediately and 1 month after boot camp on their desire to incorporate surgical skills into practice.Main Outcome Measure(s)Efficiency of laparoscopic suturing and knot tying before and after boot camp; likelihood and persistence of incorporating surgical skills into practice immediately and 1 month after boot camp; and correlation between fellowship IVF volume and fellow surgical efficiency.Result(s)Fellows experienced significant improvement in laparoscopic suturing (44 sec), intracorporeal knot tying (82 sec), and extracorporeal knot tying (71 sec). Fellows reported being more likely to incorporate operative hysteroscopy (89%), operative laparoscopy (87%), and laparoscopic suturing (84%) into practice immediately following boot camp with no difference 1 month later. Fifty-four percent of fellows reported being more likely to perform robotic surgery after the boot camp, increasing to 70% 1 month later. There were weak correlations between IVF case volume and efficiency in laparoscopic suturing or hysteroscopic polypectomy (Spearman correlation coefficients, -0.14 and -0.03).Conclusion(s)An intensive surgical boot camp enhances surgical skill among REI fellows.

EFFECTIVENESS OF A NEW, LOWER-COST MANUAL HYSTEROSCOPIC TISSUE REMOVAL DEVICE (POLYGON) IN AN OFFICE SETTING

This retrospective single site case series was carried out to evaluate the effectiveness of a new, lower-cost manual hysteroscopic tissue removal device (Polygon) in an office setting. Retrospective single site in an office setting Six consecutive premenopausal women previously diagnosed by sonohystogram with presumed endometrial polyps underwent hysteroscopic polypectomy by two different surgeons using a new manual hysteroscopic tissue removal device (Polygon) through a 6.25 mm 0 degree hysteroscope (Myosure, Hologic Inc). Hysteroscope insertion and removal times, device insertion and removal times, fluid used and number of polyps removed were recorded. In all six patients, the pathology was completely removed. The average total case time was 7.3 minute (range 5-10) although the average time the device was inserted to remove the pathology was only 4 minutes (range 2-6). The average fluid used was 900 cc (range 500-1350). Three women had 1 polyp removed, two women had 2 polyps removed and 1 woman had 5 polyps removed. A new, lower cost manual hysteroscopic tissue removal device (Polygon) is effective in quickly removing endometrial polyps in an office setting and merits further evaluations to compare it with other current technologies.

THE CORRELATION BETWEEN SALINE INFUSION SONOGRAM FINDINGS AND HISTOPATHOLOGY IN THE MANAGEMENT OF INTRAUTERINE FILLING DEFECTS IN INFERTILE PATIENTS

In infertile patients, the natural course of endometrial polyps remains unclear and the current evidence on their management is mixed. Surgical resection of endometrial polyps is recommended prior to infertility treatment in order to increase natural conception or assisted reproductive pregnancy rates. Hysteroscopic polypectomy remains the gold standard for surgical treatment. However, there is scarcity of literature examining the correlation between ultrasound findings of small polyps or intrauterine filling defects and histology in patients treated for infertility.

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.

Endometrial polyps in postmenopausal women: results of a comparative analysis of clinical features after hysteroscopic polypectomy

Aim. To evaluate the clinical features of endometrial polyps (EP) in postmenopausal patients based on a comparative analysis of symptomatic and asymptomatic forms.&#x0D; Мaterials and methods. A retrospective cohort study was conducted with the inclusion of 92 postmenopausal women who underwent hysteroscopic polypectomy in the gynecological Department of the Clinical Hospital of Russian Railways-Medicine Omsk in 20182019. Тhe аverage age of patients was 60.356.56 years. Two groups of patients were identified: group 1 included patients with asymptomatic EP (n=64), group 2 women with EP associated with uterine bleeding (n=28).&#x0D; Results. Postmenopausal EP patients had: asymptomatic (69.6%), uterine bleeding (30.4%), recurrent EP (14.3%), concomitant tamoxifen treatment (5.4%), single (77.2%) and multiple (22.8%) EP. In group 1, patients with late postmenopausal stage (73.4%) with single EP (76.6%) of various localization, glandular-fibrotic type (78.1%, p0.05) prevailed. Group 2 was dominated by patients with early postmenopausal stage (60.7%, p0.05) with single EP (78.6%, p0.05) of various localization, having glandular (50%, p0.01), glandular-fibrotic (46.4%, p0.01) EP and adenomatous EP with malignancy (3.57%, p0.05). Hyperplasia of endometrium was observed in both groups (1.56 and 3.57% in group 1 and 2, respectively), and adenocarcinoma in group 1 (1.56%).&#x0D; Conclusion. In patients with postmenopausal EP, along with a benign course, the disease occurs against the background of atypical hyperplasia and endometrial cancer (in the polyp or endometrium) in 3,3% of cases, including the asymptomatic nature of the disease.

Value of Ultrasonographic Guidance For Operative Hysteroscopy on the Safety and Outcome of the Procedure: Randomized Control Trial

Abstract Background Hysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopic polypectomy, myomectomy are just a few of the commonly performed procedures. Hysteroscopy has nearly replaced standard D&amp;C for the management of abnormal uterine bleeding (AUB), as it allows for direct visualization and diagnosis of intrauterine abnormalities, and it often offers an opportunity for simultaneous treatment. Operative hysteroscopy is a safe procedure resulting in complication in 0.95-3% of cases. The most frequently observed complications include hemorrhage (2.4%), uterine perforation (1.5%), and cervical laceration (1-11%). Another rare complication is excessive fluid absorption with or without resultant hyponatremia. Can use of ultrasound guidance during operative hysteroscopy decrease the rate of the operative complication? Objective To assess the value of ultrasound guidance for operative hysteroscopy on decreasing the complication and improving the success rate of the procedure. Patients and Methods It is estimated that a sample size of 88 patients that were divided to 44 patients in the Ultrasound guidance group and 44 patients in the group that didn’t perform ultrasound. The patients were encountered from those presented at the gynecology clinic of the Ain Shams university hospital or those presented at ECDU with the inclusion criteria in the period between December 2017 to November 2018. The patients were approached to participate on study and a written informed consent was taken from all the patients. Results Comparative study between the 2 groups revealed; highly significant increase in success rate in ultrasound guided hysteroscopy (USH) group; compared to conventional hysteroscopy (CH) group; with highly significant statistical difference (p &amp;lt; 0.01) and non-significant difference as regards failure and complications rates (p &amp;gt; 0.05). Conclusion Our study found that ultrasound assistance for difficult hysteroscopy reported that ultrasound appears to be a safe and reliable method of assistance.

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.

Retrospective Cohort Study on the Symptomatic Recurrence Pattern after Hysteroscopic Polypectomy.

Objectives:The recurrence rate of benign endometrial polyps after a hysteroscopic polypectomy is low, between 0% and 15%. There are limited follow-up duration data on recurrence factors for benign polyps after hysteroscopic polypectomy, including recurrences with Versapoint® versus resectoscope. This study aims to estimate the rate of symptomatic recurrence following hysteroscopic polypectomy and to analyze the possible risk factors involved with Versapoint® versus resectoscope.Materials and Methods:We designed a retrospective cohort study in a tertiary university hospital in Seville (Spain) which looked at the results of polypectomy with a 9-mm resectoscope on 42 women between 2008 and 2015 compared to 151 women using Versapoint® during 2014.Results:The rate of first recurrence was 24.35%. There was a strong positive correlation between the recurrence and the follow-up duration (odds ratio [OR] = 2.58; 95% confidence interval [CI] = 1.68–5.04; P = 0.000), the polyps causing abnormal uterine bleeding (OR = 2.5; 95% CI: 1.1–3; P = 0.04), and a polyp size >15 mm (OR = 1.63; 95% CI = 1.3–3.1; P = 0.02). There were no statistical differences in polyps' recurrence among the types of hysteroscopic polypectomy (P > 0.05).Conclusion:The main risk factors for recurrence were polyps causing abnormal uterine bleeding, size, and follow-up duration.