Hysteroscopy is a safe and effective method for resection of polyps under direct visualization. In recent years, the development of small caliber hysteroscopes as well as bipolar electrosurgical systems have allowed to perform most polypectomies in an office setting, in a procedure that is both diagnostic and therapeutic (“see and treat”). The average duration of outpatient polypectomy procedure ranges between 8 and 17 minutes with a reported success rate of 90-100%.
The main reason of failure of in office hysteroscopy are pain (which represent the most common cause of taking the patient to the operating room), the number and size of polyps, cervical stenosis, vasovagal syndrome, incomplete excision (provided that the test is well tolerated can be completed in a second procedure) and exceptionally bleeding that hinders adequate visualization.
When performing in office hysteroscopy small caliber hysteroscopes (under 5 mm) are often used. Hysteroscopists generally lean towards the use of rigid hysteroscopes due to their better image resolution. Of these the one that we use the most is the continuous flow hysteroscope, with 2.8 mm optical with 30º angle lens, outer sheath of 4.5 to 5.5 mm and a 5 Fr operative channel. The use of small gauge hysteroscopes such as Bettochi type allows to perform polypectomy in a less traumatic way as compared with the use of resectoscope. For in office hysteroscopic surgery it is essential to have hysteroscopic graspers, scissors and bipolar energy devices. The bipolar electrode (Versapoint® Gyrus®) allows vaporization, cutting and drying of the tissue under direct visualization.