A randomised controlled trial comparing outpatient versus daycase endometrial polypectomy

Abstract

Objective To evaluate outpatient versus daycase endometrial polypectomy by comparing success rate, complications, patient tolerance, pain score, analgesia requirement and recovery.Design A randomised controlled trial.Setting A large UK Teaching hospital.Population Forty consecutive women diagnosed with an endometrial polyp at outpatient hysteroscopy were randomly assigned in equal proportions to outpatient or daycase polyp removal.Methods The outpatient cohort underwent endometrial polypectomy either using grasping forceps or a bipolar electrode (Versapoint TM ; Gynecare Inc., Menlo Park, CA, USA) introduced down the operating channel of a rigid hysteroscope (Versascope TM ; Gynecare Inc.). The daycase cohort underwent traditional endometrial polyp resection using a hysteroscopic, monopolar, electrosurgical resecting loop, performed under general anaesthetic.Main outcome measures The main outcome measures were as follows: success rates and intra or postoperative complications, time away from home, analgesia requirements, pain scores on the day of and one day after endometrial polypectomy, return to work and preoperative fitness and preference for the location of a future endometrial polypectomy.Results The majority of women from both cohorts were premenopausal (62.5%), parous (85%) and in paid employment (62.5%). One woman allocated to outpatient polypectomy had cervical stenosis and dilatation was unsuccessful in the outpatient setting. There were no other intra or postoperative complications in either arm of the study. The mean intraoperative visual analogue style (0-100 mm) pain score during outpatient polypectomy was 23.7 mm (1-62). A proportion of women (20%) described no intraoperative discomfort; however, the majority (75%) described mild or moderate intraoperative discomfort. More women in the outpatient cohort (58%) described themselves as pain free for the remainder of the day than in the daycase cohort (28%) (P = 0.09). The day after the procedure, all women from the outpatient group described slight or no discomfort compared with only 41% of women from the daycase group (P = 0.02). All women undergoing outpatient polypectomy had a significantly shorter mean time away from home (3.24 [1.5-5] hours) than women undergoing daycase polypectomy (7.42 [6-10.5] hours), P < 0.0005. Similarly, women from the outpatient cohort had a significantly faster mean return to preoperative fitness (1 [0-4] day versus 3.2 [1-13] days; P = 0.001) and required less postoperative analgesia than the daycase cohort. Ninety-five percent of women from the outpatient cohort and 82% of women from the daycase cohort stated they would prefer to undergo an endometrial polypectomy in the outpatient setting should they require a further polyp removal.Conclusion Endometrial polypectomy can be successfully performed in the outpatient setting with minimal intraoperative discomfort, a significantly shorter time away from home and faster recovery and is preferred by women when compared with daycase polypectomy. Resources need to be made ra...

Parenterally Administered Moderate Sedation and Paracervical Block Versus General Anesthesia for Hysteroscopic Polypectomy: A Pilot Study Comparing Postoperative Outcomes

“…Given its safety and feasibility, operative hysteroscopy has become the standard for the treatment of endometrial polyps, which affect 10% of premenopausal and 20% of postmenopausal women with abnormal uterine bleeding including endometrial/endocervical polyps [2,3]. Most operative hysteroscopies are performed in the setting of an operating room under general anesthesia [4,5], causing major costs and risk of failure in patients with serious medical conditions such as hemodynamic instability, laryngospasm, bronchial asthma, and a previous reaction to general anesthesia [6].…”

Future research and developments in hysteroscopy

“…In a prospective trial, 40 patients were randomized to undergo outpatient hysteroscopic polypectomy using mechanical instruments or bipolar electrode versus day surgery using a monopolar resectoscope under general anaesthesia [7]. Outpatient polypectomy was associated with a success rate of 95%.…”

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

“…Hysteroscopic removal is standard practice in the UK 47 and in the case of polyps can be achieved in the majority of cases in the outpatient setting. [48][49][50][51] The procedures involve the use of electrosurgical cutting electrodes placed down a small operative working channel in the hysteroscope or a formal hysteroscopic resectoscope using a larger loop electrode.…”