Too big? A review of methods for removing large endometrial polyps in office minihysteroscopy - broadening the indications for the procedure in the COVID-19 pandemic.

Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. For small polyps (less than 2 cm) minihysteroscopy can be performed in an office setting. Patients with polyps larger than 2 cm are usually referred for a standard resectoscope procedure in the operation room (OR) under general anaesthesia. Those patients are exposed to longer hospital stay and possible complications of the anaesthesia. Furthermore, they usually have longer contact with many medical staff members. Limiting the time of contact as well as the number of staff involved in the procedure is particularly important during the COVID-19 pandemic. For this reason, minihysteroscopy in an office setting should be the first choice in every possible indication. We present the methods that may be useful for removing even large polyps in minihysteroscopy. The advantages and disadvantages of every procedure are discussed.

Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele-Preliminary Results.

Due to an increasing number of cesarean section deliveries, the common consequences of that surgery are observed more often in the population. One of them is the uterine cesarean scar defect known as niche or isthmocele. Most patients with that aliment are asymptomatic, but some of them can report abnormal uterine bleeding, pelvic pain, subfertility which can be the reason for reduced quality of life (QoL) of the patients. In our study, we analyzed the subjective feelings of changes in the severity of symptoms and quality of life of women with niche after diagnostic and operative hysteroscopy. The patients n = 85 included in the study group completed a follow up questionnaire six months after the procedure. Patients after operative hysteroscopy in comparison to patients after diagnostic procedure reported statistically significant reduction in post-menstruation bleeding/spotting and improvement in the quality of sexual activity. We have also noticed a higher pregnancy rate in the operative group, however, the difference was not statistically significant. According to our study, most women reported a positive effect of hysteroscopy on their QoL in social, psychological, environmental, and health domains.

Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures.

INTRODUCTION: Hysteroscopy is the gold standard for diagnosis and treatment of uterine pathologies. The office setting seems to be safe, reducing the anesthesia risks and also decreasing the overall costs of the procedure. Recent literature suggests that hysteroscopy performed without anesthesia may not be as painless as it was previously considered. Moreover, not every patient can be referred for a hysteroscopy in an office setting. AIM: To analyze the factors correlated with a successful hysteroscopy in an office setting. MATERIAL AND METHODS: We analyzed the documentation of 1301 patients who underwent hysteroscopy at our department in the period 2013-2016. The impact of the type of the procedure and the various demographic factors on the need for general anesthesia was assessed. RESULTS: Almost 80% of all hysteroscopies were performed without analgesia in an office setting. The remaining patients underwent a hysteroscopy in general anesthesia. The key aspect for successful office hysteroscopy is the scope of the performed surgery. Over 91% of diagnostic hysteroscopies have been done without analgesia, but only about 30% of extensive endometrial scratching procedures were performed in an office setting. A previous vaginal delivery increases the chances for a successful office hysteroscopy by about 21%, and in the case of diagnostic procedures, multiparous patients were at an about 79% lower risk of analgesia necessity. CONCLUSIONS: It is possible to perform nearly all diagnostic hysteroscopies in an office setting. In the case of operative hysteroscopy, the most crucial factor is the scope of the procedure.

Usefulness of Cryoprobe in Office Hysteroscopy for Removal of Polyps and Myomas.

Hysteroscopy is a gold standard in 21st-century gynaecology for both diagnosis and treatment procedures of intrauterine pathologies. Miniaturisation of the equipment and better techniques of performing this procedure allowed it to become the gold standard. Nevertheless, hysteroscopy has its limitations, which is the size of the endometrial polyps or submucous myomas. We have invented a new device for the 5Fr working channel hysteroscopes for possessing and resecting intrauterine structures: the cryoprobe. The retrospective cryobiopsy study presented here was conducted at the Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine in Warsaw, Poland, from October 2017 to January 2018. Its purpose was to assess the usefulness of the new device in office hysteroscopy for the removal of polyps and myomas with a diameter over 10 mm. Thirteen patients with an initial diagnosis of an endometrial polyp or submucous myoma were enrolled in the trial. All procedures took place in day-surgery settings, with a total resection of the pathological intrauterine structure, without complications. The application of the cryoprobe may enhance the usefulness of office hysteroscopy, without extending the procedure. The cryoprobe efficiency is still under research in a bigger group.