Outpatient Hysteroscopic Polypectomy in Postmenopausal Women: A Comparison between Mechanical and Electrosurgical Resection

Garuti, Giancarlo; Centinaio, Giovanna; Luerti, Massimo

doi:10.1016/j.jmig.2008.07.001

Cited by 47 publications

(23 citation statements)

References 29 publications

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“…Mechanical or electrosurgical outpatient polypectomy is equally safe and effective and does not differ in terms of operating time or induced pelvic discomfort (Garuti et al 2008 ). Bipolar electrodes appear to have a safer profi le compared with monopolar electrodes because of the unchanged serum sodium (Berg et al 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic Instrumentation

Istre¹,

Thurkow²

2014

Minimally Invasive Gynecological Surgery

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Section: Discussionmentioning

confidence: 99%

Hysteroscopic Instrumentation

Istre¹,

Thurkow²

2014

Minimally Invasive Gynecological Surgery

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“…Moreover, hysteroscopy systems have become miniaturised, such that they are increasingly portable and easy to insert into the uterine cavity without the need for wide cervical dilatation and blind uterine exploration. Alongside these developments, miniature ancillary instrumentation has been developed, allowing precise targeting of focal pathologies, such as uterine polyps, using a variety of mechanical and electrosurgical equipment 32,[85][86][87][88][96][97][98][99][100] (see Surgical management: polypectomy). These developments have facilitated the concept of 'see and treat' hysteroscopy in a convenient outpatient setting.…”

Section: Current Practice: Surgical Methods and Settingmentioning

confidence: 99%

“…Hysteroscopic intervention is not simply restricted to diagnosis, but when pathology amenable to treatment is identified then simultaneous treatment is carried out. 21,32,85,86,88 Despite these technological advances and the apparent safety, convenience and feasibility of outpatient intervention, as well as the high prevalence of uterine polyps associated with AUB, outpatient surgical removal of uterine polyps remains infrequently practised. As described above (see Surgical management: polypectomy), surgical polyp removal is universally practised in the UK 45 and elsewhere, although the most prevalent technique differs between the UK and the Netherlands, two countries for which national surveys of practice pertaining to polyp treatment have been conducted.…”

Section: Current Practice: Surgical Methods and Settingmentioning

confidence: 99%

“…32,[85][86][87] Potential drawbacks of mechanical instrumentation are the fragility of the instruments, limited manipulation, difficulty with cutting or avulsing large and fibrous pathology, and, in some instances, bleeding. 32,88 The adoption of electrosurgical technologies may help to overcome these difficulties. Large-diameter hysteroscopic resectoscopes that were developed originally to resect the endometrium for the treatment of HMB 89 can also be used to resect focal pathologies, such as SMFs 77,90 or polyps.…”

Section: Blind Uterine Polypectomymentioning

confidence: 99%

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A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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“…The feasibility of outpatient hysteroscopic polypectomy has been demonstrated using a variety of mechanical and electrosurgical instruments 37 38. Fine scissors and grasping forceps for use with continuous flow hysteroscopes have been largely superseded by bipolar electrodes, which provide rapid cutting, slicing through polyps or fibroids efficiently, although additional instruments such as grasping forceps or snares have to be employed to retrieve the material from the uterine cavity.…”

Section: The Role Of Ambulatory Hysteroscopy In Aubmentioning

confidence: 99%

Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding

Cooper

Robinson

Clark

2015

J Fam Plann Reprod Health Care

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Hysteroscopy is now an ambulatory procedure, having moved from a conventional day-case operating theatre environment to the outpatient clinic setting. Outpatient hysteroscopy can be used as a diagnostic test and as a therapeutic modality for women presenting with abnormal uterine bleeding. In many cases women can be diagnosed and treated efficiently during a single hospital appointment. This article reviews the development of ambulatory hysteroscopy and how it should optimally be performed and implemented. The contemporary role of this technology for investigating and treating women with abnormal uterine bleeding is then discussed.

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Outpatient Hysteroscopic Polypectomy in Postmenopausal Women: A Comparison between Mechanical and Electrosurgical Resection

Cited by 47 publications

References 29 publications

Hysteroscopic Instrumentation

Hysteroscopic Instrumentation

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding

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