Nonelectric shaving of endometrial polyp by hysteroscopy - A new technique to eliminate thermal damage

Abstract

Objective

To present a new technique for complete endometrial polypectomy, using the bipolar loop hysteroscope, but without the activation of electrical energy, and follow its efficiency and safety for the patient.

Study design

This is a prospective descriptive study conducted at a university hospital. Forty four patients were recruited to the study according to an intra uterine polyp diagnosed by transvaginal ultrasound (TVS). Out of them 25 really had an endometrial polyp which was inspected by hysteroscopy. Eighteen were at menopause age and seven in their reproductive age. The hysteroscopic removal of the endometrial polyp was performed using the operative loop resectoscope without using electricity, meaning by cold loop. We called this unique technique SHEPH: Shaving of Endometrial Polyp by Hysteroscopy.

Results

The range age was 21–77 years old. All patients with apparently endometrial polyp, underwent a complete removal of the polyp which could be directly seen through hysteroscopy. No bleeding was seen in all cases. The other nineteen patients had normal uterine cavity, so a biopsy was taken according to the indication. The specimen from all cases were sent to histological evaluation. An endometrial polyp was histologically confirmed in all cases who underwent the SHEPH technique, while fragments of an endometrial polyp was revealed by histology in six cases from the group that had normal uterine cavity. No complications were noted for the short and long periods.

Conclusions

Nonelectric Shaving of Endometrial Polyp by Hysteroscopy (SHEPH technique) is a safe and effective procedure which allows the surgeon to achieve a complete endometrial polypectomy but without using electrical energy within the body of the patient. The technique which is easy to learn, is new and unique by eliminate thermal damage in a very common gynecologic indication.

Introduction

An endometrial polyp originates from the basal layer of the endometrium [1]. It is diagnosed in 4% [2] of all women with unexplained infertility and in 14.8% of infertile women [3].

In pre-malignant and malignant conditions, Ben-Arie found endometrial polyps in 3.3% and 3.0% of women respectively, while postmenopausal or irregular vaginal bleeding were absent [4]. In another study by Lieng M et al., the prevalence of malignancy or atypical hyperplasia was 3.2% in women with symptoms and 3.9% in those without symptoms [5].

Endometrial polyps may interfere with fetal implantation [6], [7], might present a defective prior implantation site [8], or a physical obstacle deforming the cavity [9]. Using electrical energy in small postmenopausal uterus may be associated with a risk of uterine perforation. This is complicated when its base has limited accessibility. Uterine perforation is the most common complication in operative hysteroscopy, and ranges between 0.8 and 1.6 percent of operative hysteroscopies [10], [11], [12], [13], [14].

In thin postmenopausal myometrium, the perforation risk might be elevated, especially if the resection is performed by two or more bites. During fertile years, a permanent electric scar in the endometrium is further complicated with deep myometrial resections and with unicornuate uterus.

Avoiding the use of electric power within the patients’ body is preferable in all these cases. In this study, we present a new hysteroscopic technique for complete endometrial polypectomy using the existing bipolar loop hysteroscope, without the activation of electrical energy. The purpose of the current study was to show the feasibility and safety of the new technique.

The primary end point in this study, is to present a complete endometrial polypectomy by new hysteroscopic technique using the existing bipolar loop hysteroscope, without the activation of electrical energy. Secondary end points are to show the feasibility and safety of the new technique.