Outpatient operative polypectomy using a 5 mm-hysteroscope without anaesthesia and/or analgesia: advantages and limits

Abstract

Objective: To assess the predictors of office-based operative hysteroscopic polypectomy using a 5.2mm continuous flow office hysteroscope without anaesthesia and/or analgesia for the treatment of endometrial and/or isthmic polyps and to define procedure limits.

Study design: Women with hysteroscopic diagnosis of endometrial or isthmic polyps were offered to proceed in the same session with operative hysteroscopy after 15 min without anaesthesia and/or analgesia. All procedures were performed using a 5.2 mm continuous flow office hysteroscope. Patient procedure compliance was assessed by means of a visual analogue scale (VAS) using a rating scale with 11 categories. A VAS < or = 4 was considered as patient procedure compliance. Regression analysis was performed to correlate the following variables: time required, size and number of polyps with VAS. A ROC analysis was performed to assess the cut-off of the strongest predictors. The influence of previous vaginal delivery and menopausal status was correlated with the VAS.

Results: A total of 217 women underwent the office-based hysteroscopic procedure and 253 polyps were removed, among them 170 were endometrial and 83 isthmic polyps. There were 181 women with single polyps and 36 women presented multiple polyps. The size of polyps ranged from 0.5 to 5 cm. Median time of the procedure was 10 min (range 3-30 min). Regression analysis showed a statistical significative correlation between VAS and size of polyps and between VAS and operating time independent to the number of polyps. Using the ROC analysis a VAS < or = 4 was obtained when polyps were < or = 2 cm and/or time of the procedure lasted < or = 15 min. Menopausal status and previous vaginal deliveries were not significantly correlated to the VAS.

Conclusions: Office-based hysteroscopic polypectomy is a safe and feasible procedure and should be addressed in patients with endometrial or isthmic polyps < or = 2 cm in diameter, and the procedure limits in terms of patient procedure compliance are size of polyps and operating time, independent from menopausal status and previous vaginal delivery.