Hysteroscopic polypectomy

What is a Hysteroscopic Polypectomy?

Hysteroscopy is a minimally invasive surgical procedure that enables the removal of uterine abnormalities – such as polyps, submucosal fibroids, or other abnormal tissue – from the uterine cavity under direct visual guidance. Hysteroscopy also makes it possible to remove displaced or “missing” intrauterine devices (IUDs), correct abnormalities in the shape of the uterine cavity, resect adhesions, and perform other intrauterine procedures. The procedure is most commonly performed under short-term intravenous anaesthesia, although in some cases, it can be carried out without anaesthesia. We use small-diameter hysteroscopes, which eliminate the need for cervical dilation – an important advantage, particularly for women who have not given birth. The excised pathological tissue is sent for histological examination after surgery.

Preparing for the Test and Choosing the Right Time

• Hysteroscopic polyp resection is optimally performed immediately after menstruation or within the first 10 days of the menstrual cycle.
• If scheduling at the optimal time is not possible, preoperative hormonal preparation can be used, allowing the procedure to be performed on any day of the cycle.
• Patients should arrive at the clinic on an empty stomach – no food for at least six hours and no fluids for at least four hours before surgery. The nurse will give you the exact time of arrival at the time of making the appointment.

Required Tests and Referrals for Patients Undergoing Hysteroscopic Polyp Resection with Short-Term Intravenous Anaesthesia

• Referral from a gynaecologist (preferably with gynaecological ultrasound images)
• Blood test: complete blood count, blood group, Rh factor, INR, PT, urea, creatinine, ALT, bilirubin, urinalysis, HCV, HBV, RPR, TPHA, HIV
• Electrocardiogram with conclusion

Required Tests and Referrals for Patients Undergoing Hysteroscopic Polyp Resection without Anaesthesia

• Referral from a gynaecologist (preferably with gynaecological ultrasound images)
• Blood test: complete blood count, blood group, Rh factor, INR, PT, urea, creatinine, ALT, bilirubin, urinalysis, HCV, HBV, RPR, TPHA, HIV

How does a Hysteroscopic Polyp Resection Work?

In our clinic, hysteroscopic polyp resection is performed using the “no-touch” technique, in which a small-diameter hysteroscope is introduced through the vagina and into the uterus without the need for additional instruments, thereby avoiding cervical dilation with dilators. The procedure begins with a vaginoscopy, performed without the use of speculums or tenacula, during which the hysteroscope is advanced to the cervix under direct visual guidance. Using warm and sterile saline, gentle cervical dilatation is performed, which allows penetration of the uterine cavity. The shape of the cavity, its size, the fallopian tubes, and the endometrium are assessed. During surgery, the polyp is removed either mechanically – using scissors or a specialised IBS instrument – or with laser energy. The excised material is sent for histological examination.

Other surgeries that can be performed hysteroscopically:

• resection of a cervical canal polyp;
• resection of endometrial hyperplasia;
• resection of submucosal uterine fibroids;
• removal of uterine adhesions;
• uterine septal transection;
• evacuation of a trapped spiral;
• vaporisation of adenomyosis lesions;
• repair of caesarean scar defect.

Recovery after Surgery under Short-Term Anaesthesia

You can go home a few hours after the surgery.

After a hysteroscopy, it is recommended to rest for 24–48 hours. You can resume exercising and other more intensive activities 2–3 days after surgery. Abstain from intercourse, swimming, taking a bath and using a sauna for 2 weeks. Further recommendations are made before the patient is discharged home.