Papalampros P, Gambadauro P, Papadopoulos N, Polyzos D, Chapman L, Magos A.
University Department of Obstetrics and Gynaecology, The Royal Free Hospital, Hampstead, London, UK.
Acta Obstet Gynecol Scand. 2009;88(2):227-30. [Epub on 2008 Nov 20:1-4]
Background. Outpatient hysteroscopy has become well-established for the investigation abnormal uterine bleeding. Although “See and Treat” clinics have been widely introduced, the types of procedures offered are limited, and many patients with intrauterine pathology continue to be admitted as in-patients for hysteroscopic surgery. We wanted to investigate the feasibility and acceptability of surgery for small intrauterine lesions without the need for general anesthesia by using a miniature resectoscope. Methods. This was a prospective observational study on 30 women with abnormal uterine bleeding associated with endometrial polyps or small (<3 cm) type 0 or 1 submucous fibroids. Hysteroscopic polypectomy (n=26) or myomectomy (n=4) was carried out using a 16 Fr gauge mini-resectoscope. Results. Ten procedures were carried out in the outpatient clinic and 20 in the operating theatre. Sixteen procedures were done without any anaesthesia and 14 after intra-cervical local anesthetic injections. The polyps and fibroids ranged in size from 1 to 5 cm, and all procedures took less than 15 minutes from the time the vagina was instrumented to the end of surgery. All procedures were completed successfully and were well tolerated with little discomfort. There were no complications. Conclusions. The mini-resectoscope appears to be an efficient and acceptable instrument for hysteroscopic surgery and can be used without general anesthesia for minor procedure such as polypectomy and the resection of small submucous fibroids.