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. 2024 Aug 1;1(3):21.
doi: 10.1097/og9.0000000000000021. eCollection 2024 Sep.

Extent of Myometrial Resection With Various Surgical Methods for Endometrial Polypectomy Procedures

Emily Evans-Hoeker  1 , Adrienne Millner  1 , Grace Lee  1 , Ryan Perry  1 , Ayesha Kar  1 , Meyha Swaroop  1 , Tonja Locklear  1 , Brian Newman  1 , James Casey  1
Affiliations

Extent of Myometrial Resection With Various Surgical Methods for Endometrial Polypectomy Procedures

Emily Evans-Hoeker et al. O G Open. .

Abstract

Objective: To assess whether the frequency and extent of myometrial resection differs among surgical methods commonly used for endometrial polypectomy.

Methods: We conducted a retrospective cohort study of pathology samples from polypectomy procedures performed on patients 18-50 years of age. Samples were reevaluated by a blinded pathologist to assess the following primary outcome measures: presence and percentage of myometrium on the pathology sample, prevalence of isolated myometrium, and depth of myometrial resection. Data were evaluated using Fisher exact test and Kruskal-Wallis test, followed by multiple comparisons analysis. To maintain a familywise error rate of 5% across all four primary analyses, the Bonferroni correction method was applied.

Results: Of 458 pathology samples, 21.8% were obtained using hysteroscopic morcellators, 11.1% were obtained with hysteroscopic scissors, and 67.0% were obtained with hysteroscopy with dilation and curettage (D&C). Hysteroscopic morcellation demonstrated a higher prevalence of myometrium (58.0% vs 9.8% and 15.3%, for hysteroscopic scissors and hysteroscopy with D&C, respectively; P<.001), a larger percentage of pathology samples with more than 25% myometrium (26.0% vs 4.0% and 0.6%, respectively; P<.001), and a higher prevalence of isolated myometrium compared with hysteroscopy with D&C (11.0% vs 0.7%; P<.001).

Conclusion: The presence and proportion of myometrium in polypectomy samples obtained using hysteroscopic morcellators was significantly higher compared with hysteroscopic scissors and hysteroscopy with D&C.

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Figures

Fig. 1.
Fig. 1.. Presence of myometrium and isolated myometrium on pathology samples. Percentage of pathology specimens with myometrium present is demonstrated on the left side of the graph, and percentage of pathology specimens with isolated myometrium (myometrium without adjacent endometrium) is on the right. Pairwise comparisons indicated that the hysteroscopic morcellator had statistically more myometrium present than the scissors or dilatation and curettage (D&C) methods. It had statistically more isolated myometrium present than the D&C method only.
Fig. 2.
Fig. 2.. Percentage of myometrium present on pathology samples. Data represent the amount of myometrium on pathology samples presented as a percentage of the total tissue. Pairwise comparisons indicated that the breakdown of the percentage of myometrial resection (mm) was statistically higher with the hysteroscopic morcellator than with the hysteroscopic scissors (P<.001) or hysteroscopy with dilatation and curettage (D&C) (P<.001). There was no significant difference between the hysteroscopic scissors or the hysteroscopy with D&C methods (P=.042) when applying the Bonferroni correction for pairwise comparisons.
Fig. 3.
Fig. 3.. Depth of myometrial resection in sections adjacent to endometrium on pathology samples. The Dwass, Steel, Critchlow-Flignor multiple comparisons indicated that the depth of myometrial resection (mm) was statistically increased with the hysteroscopic morcellator compared with hysteroscopy with dilatation and curettage (D&C) only (P<.001).
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