Retrospective study (Canadian Task Force classification II-2).
SETTING: Public hospital.
PATIENTS: Office polypectomy with
anesthetic paracervical block (120 patients) or without (117 patients) using either mechanical (104 patients) or bipolar coaxial electrosurgical (107 patients) instrumentation. In 26 patients, we stopped the procedure before surgery because of intervening adverse events or
polyps judged unresectable with an office-based procedure. A 10-cm visual analog scale (VAS) was used to rate patients'
pelvic pain perception.
MEASUREMENTS AND MAIN RESULTS: Overall effective
polyp resection rate was 81.2% (191 of 235 evaluable patients). An inverse, although not significant (r = -.44) correlation was found between accomplished polypectomies and
polyp size, ranging from 96.0% to 18.7% when the diameter of
polyps was below 1 cm and above 4 cm, respectively (50 of 52 and 3 of 16 successfully accomplished procedures, respectively). No significant differences were found between successful resection rates (83.3% and 80.2%, respectively; p = .10) and VAS scores (2.2 +/- 2.6 and 3.6 +/- 2.9, respectively;
p = .30) obtained in 79 premenopausal and 156 postmenopausal patients.
Paracervical block administration (118 evaluable patients) matched with no
anesthetic support (117 patients) was not associated either with an improved rate of resection (85.5% and 76.9%, respectively; p = .10) or with
pelvic pain perception (VAS scores 3.3 +/- 2.9 and 3.0 +/- 2.8, respectively; p = .94). Visual analog scale scores were significantly lower (2.8 +/- 2.5 and 4.7 +/- 3.6, respectively; p = .001) and
polyp resection rates were significantly higher (84.3% and 67.4%, respectively; p = .01) in 192 parous versus 43 nulliparous patients. Polypectomy failed in 44 of 235 patients (18.7%); the leading causes of failure were intolerable
pelvic pain in 18 patients (7.6%) and
polyp size in 17 patients (7.2%). Other than
pelvic pain, the only adverse event we observed was clinical vasovagal reaction in four patients (1.7%).
CONCLUSION: One-stop outpatient hysteroscopic polypectomy is effective in about 80% of patients. With proper preoperative selection, it can be offered as a reliable option to avoid
general anesthesia and resectoscopic surgery.