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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_207_библиотеки_им_акад_М_И_Перельмана
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Te ch Fig ure 3.4.4. Separat ed polyp from the uterine wall.
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Sharp curettage
A sharp uterine curette can also be used to remove the polyp by way of a standard dilation and curettage (D&C). The polyp
should be visualized initially with the hysteroscope, and after curettage the cavity should be reinspected to insure that the
polyp was removed in its entirety.
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Electric powered morcellation
Polyps can be removed using hysteroscopic morcellation devices such as the MyoSure
®
(Hologic Inc., Marlborough, MA)
and Truclear
®
(Smith & Nephew, Andover, MA).
Both of these devices work in a similar fashion to cut the polyp while simultaneously suctioning the fragments out of the
uterus. These devices can aid in the removal of larger polyps, but can add a significant cost to the procedure.
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Polyp removal from the uterine cavity
Small polyps can be grasped with a hysteroscopic forceps and directly removed by pulling the polyp close to the end of the
scope, then withdrawing the scope unit out of the uterus, pulling the polyp with it (Tech Fig. 3.4.5).
Larger polyps may be removed by grasping them blindly with polyp forceps. Caution should be exercised with any blind
procedure. The polyp forceps can grab and tear myometrium or lead to uterine perforation.
If the removal cannot be completed with the above steps, the cervix can be dilated up enough to allow use of a power
morcellation device, resectoscope, or passage of a larger instrument such as a sponge forceps.
After removal, repeat visualization of the cavity should be performed to ensure that the entire specimen was removed.
Te ch Fig ure 3.4.5. Polyp grasped with forceps while withdrawing hysteroscope out of t he uterus.
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PEARLS AND PITFALLS
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POSTOPERATIVE CARE
Some self-limiting bleeding is to be expected following the procedure.
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OUTCOMES
Studies have not adequately evaluated the improvement in fertility after removal of polyps. Recurrence of polyps has been
reported to occur in 13% to 43% of patients, with a higher risk of recurrence with larger numbers of polyps present,
hyperplastic polyps without atypia, and increased time to follow up.
4,5
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COMPLICATIONS
Incomplete removal
Uterine perforation
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KEY REFERENCES
1. Salim S, Won H, Nesbitt-Hawes E, et al. Diagnosis and management of endometrial polyps: a critical review of the
literature. J Minim Invasive Gynecol. 2011;18(5):569–581.
2. Lee SC, Kaunitz AM, Sanchez-Ramos L, et al. The oncogenic potential of endometrial polyps: a systematic review and
meta-analysis. Obstet Gynecol. 2010;116(5):1197–1205.
3. Pereira N, Petrini AC, Lekovich JP, et al. Surgical management of endometrial polyps in infertile women: a comprehensive
review. Surg Res Pract. 2015;2015:914390.
4. Paradisi R, Rossi S, Scifo MC, et al. Recurrence of endometrial polyps. Gynecol Obstet Invest. 2014;78(1):26–32.
5. Yang JH, Chen CD, Chen SU, et al. Factors influencing the recurrence potential of benign endometrial polyps after
hysteroscopic polypectomy. PLoS One. 2015;10(12):e0144857.
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Chapter 3.5
Uterine Myomectomy
Travis W. M cCoy, Steve n T. Nak ajima
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