Repeat hysteroscopic polypectomy: Impact of hysteroscopic instrumentation and provision of anesthesia

To determine the association of repeat polypectomy with patient and/or polyp characteristics, surgical setting, and type of hysteroscopic equipment.

Retrospective cohort study including all women who had undergone operative hysteroscopy for the removal of endometrial polyps between 1/2012-12/2022 in our division. Operative hysteroscopy with resection of endometrial polyps was performed using a bipolar loop resectoscope, miniaturized hysteroscopic instruments (bipolar needle, scissors, and graspers), or a tissue-removal device (from April 2021), with or without general anesthesia.

Benign polyps were removed in 722 women in an outpatient setting and without any anesthesia (n = 64, 8.9 %) or in an operating theatre under general anesthesia (n = 658, 91.1 %). Their mean age was 55.8 ± 12.4 years, 432 (59.8 %) were menopausal, and 41 (5.7 %) reported having previously undergone a polypectomy. The mean size of the resected polyp was 19.9 ± 8.0 mm, and ≥ 2 polyps were removed in 188 (26.0 %) cases. Repeat polypectomy was performed in 32 (4.4 %) women after 3.0 ± 1.9 years, and it was significantly more common among women whose index polypectomy was performed in an outpatient setting (12.5 % versus 3.6 % operating theatre, p = 0.005), and in women who underwent polypectomy by miniaturized hysteroscopic instruments compared with a loop resectoscope or a tissue removal device (8.3 %, 4.2 %, and 0 %, respectively, p = 0.03). On the multivariate analysis, hysteroscopy without anesthesia was significantly associated with repeat polypectomy (odds ratio = 3.5, 95 % confidence interval 1.1-12.1, p = 0.04), while the choice of hysteroscopic equipment was not (odds ratio = 1.1, 95 %, confidence interval 0.3-3.5, p = 0.9). Patient age, menopausal status, and size and number of polyps were not significantly associated with repeat polypectomy.

Repeat hysteroscopic polypectomy is relatively uncommon and possibly associated with the choice of hysteroscopic equipment and provision of anesthesia.