A new method of transvaginal ultrasound-guided polypectomy: a feasibility study

A new device has been manufactured (Safe T Choice), which allows attachment of a transvaginal ultrasound probe to a specially adapted cervical tenaculum. This affords the capacity to monitor intrauterine surgical procedures without the need for hysteroscopy. The purpose of this study was to investigate the feasibility of endometrial polypectomy using this device combined with saline contrast sonohysterography (SCSH) to monitor the procedure.

Women diagnosed with an endometrial polyp on routine B-mode two-dimensional transvaginal ultrasound (TVS) were invited to join the study. Transvaginal ultrasound-guided polypectomies were carried out by a single operator. The procedure was timed from application until removal of the tenaculum. The ultrasound views were rated as satisfactory or poor. Success of the procedure was gauged by complete removal of the polyp without recourse to hysteroscopy. Women also attended for postoperative follow-up ultrasound scans to check for residual disease.

Thirty-seven women were recruited to the study. The mean operating time was 8 min (95% CI, 5.9-10.4). The procedure was successful in 32/37 (86.5%) cases (95% CI, 75.5-97.5). In three cases (8.1%) the procedure failed because of an inability to obtain satisfactory images of the uterine cavity, and in two further cases (5.4%) the operator was unable to grasp and remove the polyp. Two patients (5.4%) bled from the tenaculum insertion site, necessitating suture for hemostasis. There were no other complications and none of the patients had evidence of residual polyp tissue at the follow-up visit.

This study showed that transvaginal ultrasound-guided polypectomy is a feasible technique for the removal of endometrial polyps. Further work is required to compare outcomes and cost-effectiveness of this technique with hysteroscopic polypectomy.