Feasibility and Acceptability of Office-Based Polypectomy With a 16F Mini-Resectoscope: A Multicenter Clinical Study

Study Objective: To investigate the feasibility and acceptability of office hysteroscopic polypectomy using a novel continuous-flow operative 16F mini-resectoscope. Design: Multicenter prospective case series (Canadian Task Force classification III). Setting: "SS Antonio e Biagio" Hospital, Alessandria, and University "Federico II" of Naples. Patients: One hundred eighty-two patients with endometrial polyps. Interventions: Hysteroscopic polypectomy performed with 16F mini-resectoscope in an office setting, without analgesia and/or anesthesia. Measurements and Main Results: Polypectomy was successfully performed in 175 patients in a single surgical step (96.15%), with only 1 patient (54%) requiring a second office surgical step to complete the surgery. Seven patients (3.84%) were excluded from the analysis of operative parameters because of severe pelvic pain during the office procedure, which required a second inpatient surgical step. No major complications were recorded. Conclusion: Our findings demonstrate that removal of endometrial polyps using the 16F mini-resectoscope in an office setting is a feasible and safe surgical option. Outpatient see-and-treat polypectomy is an acceptable and effective alternative to inpatient resectoscopic polypectomy

Hysteroscopy During Menopause

Menopause is characterized by permanent cessation of menstrual periods, and clinically defined after 12 months of complete amenorrhea. It occurs at a median age of 51 alongside with the physiological process of ageing, although it can happen at an earlier age for other medical conditions or after surgery (surgical menopause). Due to reduced estrogen and progesterone levels, reproductive organs undergo progressive atrophy. This reflects also at endometrial level: without the cyclic hormonal actions of the menstrual cycle, the endometrium in menopause becomes atrophic. Nevertheless, many other intrauterine pathologies, such as endometrial or cervical polyps, submucous myomas, and uterine septa, may all be diagnosed during menopause. In addition, the possibility offered by hormone replacement therapy modifies the endometrium, which may proliferate under hormonal stimuli. In this chapter we report common scenarios observed during hysteroscopy in postmenopausal women, with emphasis on indications, diagnostic/therapeutic role of hysteroscopy when performed during menopause, and limits of the technique

Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial

Background: The aim of this study is to assess the prevalence of atypical hyperplasia (AH) and endometrial cancer (EC) within endometrial polyps (EPs) removed by hysteroscopy. Methods: Hysteroscopic polypectomy interventions were performed over 1436 consecutive patients with Eps to complete a prospective observational trial (Canadian Task Force Classification II-2) including 19 Italian Gynecologic Departments (University-Affiliated or Public Hospitals) for a secondary multicenter analysis. Results: At histological analysis, in 1404 patients (97.8%) EPs were classified as benign, whereas in 32 patients (2.2%) EPs were diagnosed as atypical (i.e. with AH or EC). Specifically, AH and EC were found in 17 (1.2%) and 15 (1.0%) cases, respectively. Risk factor analysis showed that menopausal status, BMI and size of EPs were associated with increased risk of atypical EPs (p<0.0001). Abnormal uterine bleeding, EPs number, contraceptive therapy and tamoxifen were not associated with increased risk of atypia (p=ns). The cut-off points for increased risk of atypical polyps were 54.2 years old, BMI of 25.3 and EP size of 2.2 cm. Hysterectomy specimens were analyzed in 21 women with atypical EPs, showing the concomitant presence of atypical tissue in non-polypoid endometrium in the majority of patients (n=14 women, 66.6%). Conclusion: The prevalence of endometrial cancer and atypical hyperplasia in endometrial polyps is low, although it is increased in women who are overweight, older than 54 years of age or with a polyp larger than 2cm

Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial

Background: The aim of this study is to assess the prevalence of atypical hyperplasia (AH) and endometrial cancer (EC) within endometrial polyps (EPs) removed by hysteroscopy.Methods: Hysteroscopic polypectomy interventions were performed over 1436 consecutive patients with Eps to complete a prospective observational trial (Canadian Task Force Classification II-2) including 19 Italian Gynecologic Departments (University-Affiliated or Public Hospitals) for a secondary multicenter analysis.Results: At histological analysis, in 1404 patients (97.8%) EPs were classified as benign, whereas in 32 patients (2.2%) EPs were diagnosed as atypical (i.e. with All or EC). Specifically, All and EC were found in 17 (1.2%) and 15 (1.0%) cases, respectively. Risk factor analysis showed that menopausal status, BMI and size of EPs were associated with increased risk of atypical EPs (p<0.0001). Abnormal uterine bleeding, EPs number, contraceptive therapy and tamoxifen were not associated with increased risk of atypia (p=ns). The cut-off points for increased risk of atypical polyps were 54.2 years old, BMI of 25.3 and EP size of 2.2 cm. Hysterectomy specimens were analyied in 21 women with atypical EPs, showing the concomitant presence of atypical tissue in non-polypoid endometrium in the majority of patients (n=14 women, 66.6%).Conclusion: The prevalence of endometrial cancer and atypical hyperplasia in endometrial polyps is low, although it is increased in women who are overweight, older than 54 years of age or with a polyp larger than 2cm

Effectiveness of Hysteroscopic Techniques for Endometrial Polyp Removal: The Italian Multicenter Trial

STUDY OBJECTIVE: To compare the effectiveness and safety of different techniques of hysteroscopic polypectomy. DESIGN: Multicenter, prospective observational trial (Canadian Task Force classification II-2). SETTING: Nineteen Italian gynecologic departments (university-affiliated or public hospitals). PATIENTS: Consecutive patients suffering from endometrial polyps (EPs). INTERVENTIONS: Hysteroscopic polypectomy, as performed through different techniques. MEASUREMENTS AND MAIN RESULTS: Included in the study were 1404 patients (with 1825 EPs). The setting was an ambulatory care unit in 40.38% of the cases (567 women), of whom 97.7% (554) did not require analgesia/anesthesia. In the remaining 59.62% of women (837 women), the procedures were performed in an operating room under mild sedation, local or general anesthesia. Minor complications occurred in 32 patients (2.27%), without significant differences between the techniques used (p = ns). Uterine perforation occurred in 14 cases, all performed in the operating room with some kind of anesthesia, only 1 with a vaginoscopic technique and the remaining during blind dilatation (odds ratio [OR], 19.98; 95% confidence interval [CI], 1.19-335.79; p = .04). An incomplete removal of EPs was documented in 39 patients. Logistic regression analysis showed that a higher risk of residual EPs was associated with the use of a fiber-based 3.5-mm hysteroscope (OR, 6.78; 95% CI, 2.97-15.52; p &lt;.001), the outpatient setting (OR, 2.17; 95% CI, 1.14-4.14; p = .019), and EPs located at the tubal corner (OR, 1.98; 95% CI, 1.03-2.79; p = .039). No association between incomplete EP removal and EP size or number was recorded (p = ns), as well as with the other variables evaluated. CONCLUSION: Outpatient polypectomy was associated with a minimal but significantly higher risk of residual EPs in comparison with inpatient polypectomy. Conversely, inpatient polypectomy was associated with a considerably higher risk of uterine perforation and penetration in comparison with office hysteroscopy. Because of lower intraoperative risks and higher cost-effectiveness, office hysteroscopy may be considered, whenever possible, as the gold standard technique for removing EPs

Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial

Background:The aim of this study is to assess the prevalence of atypical hyperplasia (AH) and endometrial cancer (EC) within endometrial polyps (EPs) removed by hysteroscopy. Methods:Hysteroscopic polypectomy interventions were performed over 1436 consecutive patients with Eps to complete a prospective observational trial (Canadian Task Force Classification II-2) including 19 Italian Gynecologic Departments (University-Affiliated or Public Hospitals) for a secondary multicenter analysis. Results:At histological analysis, in 1404 patients (97.8%) EPs were classified as benign, whereas in 32 patients (2.2%) EPs were diagnosed as atypical (i.e. with AH or EC). Specifically, AH and EC were found in 17 (1.2%) and 15 (1.0%) cases, respectively. Risk factor analysis showed that menopausal status, BMI and size of EPs were associated with increased risk of atypical EPs (p&lt;0.0001). Abnormal uterine bleeding, EPs number, contraceptive therapy and tamoxifen were not associated with increased risk of atypia (p=ns). The cut-off points for increased risk of atypical polyps were 54.2 years old, BMI of 25.3 and EP size of 2.2 cm. Hysterectomy specimens were analyzed in 21 women with atypical EPs, showing the concomitant presence of atypical tissue in non-polypoid endometrium in the majority of patients (n=14 women, 66.6%). Conclusion:The prevalence of endometrial cancer and atypical hyperplasia in endometrial polyps is low, although it is increased in women who are overweight, older than 54 years of age or with a polyp larger than 2cm

Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: A secondary analysis from the SICMIG hysteroscopy trial

The aim of this study is to assess the prevalence of atypical hyperplasia (AH) and endometrial cancer (EC) within endometrial polyps (EPs) removed by hysteroscopy

Analysis of the degree to which the recommendations of experts in hysteroscopy can be adopted

The Guidelines are an useful tool in clinical practice. However, they have one weak point: their acceptability. A \u201cGuideline\u201d is HELPFUL when applied, and is applied when it provides handy and shared information. It must involve the contribution of the experience, made of specific language and common sense, of a representative group of professionals. In order to evaluate partially overcome these limits and evaluate the acceptability of recommendations in hysteroscopy, a meeting was held in Milan. This paper presents the outcome of that meetin