Extent of Myometrial Resection With Various Surgical Methods for Endometrial Polypectomy Procedures

Abstract

OBJECTIVE: To assess whether the frequency and extent of myometrial resection differs among surgical methods commonly used for endometrial polypectomy.

METHODS: We conducted a retrospective cohort study of pathology samples from polypectomy procedures performed on patients 18–50 years of age. Samples were reevaluated by a blinded pathologist to assess the following primary outcome measures: presence and percentage of myometrium on the pathology sample, prevalence of isolated myometrium, and depth of myometrial resection. Data were evaluated using Fisher exact test and Kruskal-Wallis test, followed by multiple comparisons analysis. To maintain a familywise error rate of 5% across all four primary analyses, the Bonferroni correction method was applied.

RESULTS: Of 458 pathology samples, 21.8% were obtained using hysteroscopic morcellators, 11.1% were obtained with hysteroscopic scissors, and 67.0% were obtained with hysteroscopy with dilation and curettage (D&C). Hysteroscopic morcellation demonstrated a higher prevalence of myometrium (58.0% vs 9.8% and 15.3%, for hysteroscopic scissors and hysteroscopy with D&C, respectively; P,.001), a larger percentage of pathology samples with more than 25% myometrium (26.0% vs 4.0% and 0.6%, respectively; P,.001), and a higher prevalence of isolated myometrium compared with hysteroscopy with D&C (11.0% vs 0.7%; P,.001).

CONCLUSION: The presence and proportion of myometrium in polypectomy samples obtained using hysteroscopic morcellators was significantly higher compared with hysteroscopic scissors and hysteroscopy with D&C.