Office hysteroscopy and laser surgery in the treatment of cervical polyps

Background: Cervical polyps are usually an indication for surgical treatment. There is a vast variety of polyp removal techniques but all of them have such disadvantages as intravenous anesthesia, hospital admission, visualization difficulties and frequency of recurrence. Therefore, it is necessary to search for new effective and minimally invasive, but available cost-effective methods for both doctor and patient. Objective: To assess the effectiveness of the two-step method of the cervical polyp removal using the office-based hysteroscopic operation followed by laser destruction of the peduncle bed of the removed polyp. Materials and methods: Office hysteroscopy and the cervical polyp removal followed by laser destruction of the peduncle bed of the polyp were performed in 72 women aged 21 to 44 years (mean age is 32.9±1.4 years). The first step was to remove a polyp during office hysteroscopy using Betocchi’s method; it was followed by the laser destruction of the peduncle bed of the removed polyp under colonoscopic guidance using a semiconductor diode 9W-laser with radiation wavelength 940nm. This method was used in the removal of polyps located in the middle third of the cervical canal and closer to the external orifice of the uterus. Results: Seventy-two women of reproductive age underwent a two-stage cervical polyp removal which included removal of the polyp with scissors inserted into the biopsy canal. All of the patients noted lack of pain syndrome during the manipulation. The size of the removed polyps varied from 0.5*0.5 to 1.0*2.5 cm. The combination of cervical polyps with endometrial ones, which were also removed during hysteroscopy, was noted in 15 (20.8%) patients. The total duration of this manipulation depended on the size and localization of the polyp and the length of its peduncle, but it did not exceed 10 minutes. In all the cases the diagnosis was confirmed by histological examination. According to the morphological signs, there were fibrous polyps (65%) or glandular fibrous polyps (35%). No cases of recurrent cervical polyps were reported within 12 months after the manipulation. Conclusion: The combined two-stage method for the removal of cervical polyps localized in the middle and lower third of the cervical canal is highly effective. This method does not require hospitalization or intravenous anesthesia; it minimizes cervical canal injuries and prevents recurrences; it also reduces invasiveness, labor intensity and economic costs.

cervical polyps, recurrence of polyps, off ice hysteroscopy, laser destruction