Hysteroscopic Morcellation Compared With Electrical Resection of Endometrial Polyps: A Randomized Controlled Trial

Smith, Paul P. MBChB (Hons); Middleton, Lee J. MSc; Connor, Mary MD; Clark, T. Justin MD (Hons)

doi: 10.1097/AOG.0000000000000187
Contents: Original Research
Annual Awards

OBJECTIVE: To evaluate whether hysteroscopic morcellation or bipolar electrosurgical resection is more favorable for removing endometrial polyps in an office setting in terms of feasibility, speed, pain, and acceptability.

METHODS: A multicenter, single-blind, randomized, controlled trial of office hysteroscopic morcellation compared with electrosurgical resection was conducted. A total of 121 women were randomly allocated to polyp removal by one of the two methods in an office setting. The outcomes assessed were time taken to complete the endometrial polypectomy, defined as the time from insertion to removal of vaginal instrumentation, completeness of polyp removal, acceptability, and pain measured on a 100-mm visual analog scale.

RESULTS: The median time taken to complete the procedure was 5 minutes and 28 seconds for morcellation compared with 10 minutes and 12 seconds for electrosurgical resection (P<.001). The polyps were completely removed in 61 out of 62 (98%) women assigned to morcellation compared with 49 out of 59 (83%) women treated with electrosurgical resection (odds ratio 12.5; 95% confidence interval [CI] 1.5–100.6; P=.02). The mean pain scores during the procedure favored morcellation by 16.1 points on average (35.9 compared with 52.0; 95% CI for difference, −24.7 to −7.6; P<.001). Overall, 99% of women found office polypectomy to be acceptable, with only one woman in the electrosurgical resection group considering the procedure unacceptable.

CONCLUSION: In comparison to electrosurgical resection during hysteroscopic polypectomy, morcellation was significantly quicker, less painful, more acceptable to women, and more likely to completely remove endometrial polyps compared with electrosurgical resection.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01509313.

LEVEL OF EVIDENCE: I

Hysteroscopic morcellation appears to be quicker, more successful, less painful, and more acceptable to women than electrosurgical resection for removing endometrial polyps in an office setting.

Birmingham Women's Hospital, Birmingham and Sheffield University Hospital, Sheffield, United Kingdom.

Corresponding author: Paul P. Smith, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, West Midlands B15 2TG, United Kingdom; e-mail: paul.smith@doctors.net.uk.

Financial Disclosure Dr. Clark has received research monies from Smith & Nephew for the administration costs of this trial. In addition, he has received honoraria from Smith & Nephew and Ethicon to perform training workshops in office hysteroscopic techniques. Dr. Connor has received a consultancy fee from Smith & Nephew for work undertaken after completion of the study reported in this article. The other authors did not report any potential conflicts of interest.

The study sponsor was Birmingham Women's Hospital Foundation Trust. The administration costs of this research were supported by a research grant provided by Smith & Nephew (manufacturer of the hysteroscopic morcellator).

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.