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.Shalina M.A., Khachaturyan A.R., Yarmolinskaya M.I.
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 940 nm. 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.
Keywords
cervical polyps
recurrence of polyps
office hysteroscopy
laser destruction
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Received 07.12.2021
Accepted 21.12.2021
About the Authors
Maria A. Shalina, Ph.D. (Medicine), Senior Researcher at the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint Petersburg, Russia, amarus@inbox.ru, https://orcid.org/0000-0002-5921-3217, eLibrary SPIN: 6673-2660.Armine R. Khachaturyan, Ph.D. (Medicine), Senior Researcher at the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia; Associate Proffesor at the Department of Obstetrics, Gynecology and Reproductology, Saint-Petersburg State University,
Saint-Petersburg, Russia, armine2709@mail.ru, https://orcid.org/0000-0003-2141-6307, eLibrary SPIN: 2691-3910.
Maria I. Yarmolinskaya, MD, PhD, DSci (Medicine), Professor of the RAS, Head of the Department of Gynecology and Endocrinology, Head of the Diagnostics and Treatment of Endometriosis Center, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint-Petersburg, Russia; Professor, Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia, m.yarmolinskaya@gmail.com,
https://orcid.org/0000-0002-6551-4147, eLibrary SPIN:3686-3605.
Corresponding author: Maria A. Shalina, amarus@inbox.ru
Authors’ contributions: Yarmolinskaya M.I., Khachaturyan A.R.– the development of the concept and design of the study; Khachaturyan A.R., Shalina M.A. – collection and processing of the material; Shalina M.A., Khachaturyan A.R. – statistical data processing, text writing; Yarmolinskaya M.I. – editing the article.
Conflicts of interest: The authors declare that they have no competing interests.
Funding: The study has been performed within the basic scientific research АААА-А19-119030490009-6.
Patients’ Consent to Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Shalina M.A., Khachaturyan A.R., Yarmolinskaya M.I. Office hysteroscopy and laser surgery in the treatment of cervical polyps.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2021; 12: 160-166 (in Russian)
https://dx.doi.org/10.18565/aig.2021.12.160-166
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