Endometrial polyp removal

Today, the most common problem in gynecological practice is polyps. Removal of endometrial polyps is a mandatory procedure, since it is impossible to get rid of them in any other way. Moreover, they need to be removed as quickly as possible, since they develop into a tumor.

Polyps are benign in nature, which affect the internal walls and cavity of the uterus (endometrium). They themselves are a consequence of the proliferation of the endometrium, formed by the lining of the uterus. In most cases, they are attached to the wall of the uterus with a special stalk. With the help of modern equipment, polyps can be removed quickly, without consequences and the risk of re-growth.

How urgently is it necessary to remove an endometrial polyp?

Endometrial polyps should be removed as quickly as possible, as they tend to grow and undergo transformation into a malignant tumor. Any surgical treatment can only be effective at an early stage of pathology detection.

Preparation

It is important not to have sex for about a week before the operation, or, in extreme cases, to use a condom. It is also not recommended to use any means, especially antibacterial ones, which will help to preserve the natural state of the microflora. It is also better not to use any medications or cosmetics.

A week before the operation, it is better to stick to a diet. You cannot eat fried, spicy, smoked foods. It is better to give preference to boiled and steamed dishes with a minimum content or complete absence of seasonings, spices.

What tests are needed for hysteroscopy of endometrial polyp?

When preparing for a polyp removal procedure, it is necessary to take a number of tests and undergo an examination. Based on these studies, a decision will be made on the advisability of removing the polyp. The doctor will be able to choose the best method of removal, and the anesthesiologist will determine the most suitable anesthesia option.

During a gynecological examination, the cervix is examined in mirrors. This is important because during the operation, it is through the canal that instruments will be inserted and all necessary manipulations will be performed.

Mandatory bacterial culture is performed to exclude the risk of uterine infection, cytological examination. An electrocardiogram is required, which will allow assessing the condition and mode of work of the heart. This will allow assessing how the load during the operation will affect the work of the heart, as well as choosing the optimal anesthesia.

Of the instrumental studies, a transvaginal ultrasound examination is mandatory, which makes it possible to examine the uterus. Of the laboratory tests, a clinical blood and urine test, a study for latent infections are mandatory. Also, a necessary condition is the availability of fluorography results and a consultation with a therapist.

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On what day of the cycle is an endometrial polyp removed?

The day of the operation is determined by the doctor, most often in the first week after the end of menstruation.

Anesthesia for endometrial polyp removal

Patients are often left for inpatient treatment. Hospitalization periods are usually short, but anesthesia is required. It is selected by a doctor based on age and the presence of concomitant diseases. The drugs must meet basic requirements - be safe and provide reliable pain relief. Intravenous anesthesia is most often used.

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Removal of endometrial polyp under anesthesia

It is removed under anesthesia. The choice of anesthesia is determined and selected by the anesthesiologist individually. If you feel relatively well and the manipulation is short, it is recommended to replace general anesthesia with spinal anesthesia. Endotracheal anesthesia is also used.

Technique endometrial polyp removal

At the moment, they are conventionally divided into three types. Surgeons resort to the traditional, hysteroscopic, laparoscopic method of removal.

The traditional method of removal means a regular abdominal operation, in which the uterus is cut and the polyp is removed using standard surgical instruments. But this method is used extremely rarely, since it has long been considered outdated. Moreover, it has been established that it is dangerous and carries numerous risks. Thus, recovery takes a long time, the risk of bleeding increases. The operation is quite complex and lasts a very long time. The main difficulty is that it is necessary to consistently cut all the overlying layers, as well as the uterus itself, carry out the necessary manipulations to remove the polyp, and suture all the layers.

A safer method is hysteroscopy: it is widely used in practice. This method is considered low-traumatic, it is done under light anesthesia, which lasts only 15-20 minutes. The essence of the method is that the polyp is removed without making any incisions. All necessary manipulations are performed naturally, through the opening of the cervix with special instruments (hysteroscope). When using this method, recovery occurs quite quickly, the woman can be sent home on the same day.

One of the subtypes of hysteroscopy is curettage, which is carried out under the control of a hysteroscope. But this method is also outdated and is practically not used at present, since it is highly traumatic and often leads to serious violations of the structure and function of the uterus. The consequence of this method is often infertility.

Another popular modern method is laparoscopic removal, which is performed using a special instrument - a laparoscope. In order to remove a polyp laparoscopically, it is necessary to make a small laparoscopic access.

In essence, several punctures are made on the abdominal side in the lower abdomen. A laparoscope is first inserted through this puncture – an instrument that is equipped with a camera at the end. It allows you to examine the cavity being operated on and develop the tactics of the operation. Then, through another incision, surgical equipment is inserted, with the help of which I remove the polyp. Recovery occurs very quickly, since the surrounding tissues are practically not damaged. There are practically no scars, and postoperative pain is also practically not disturbing.

How is an endometrial polyp removed from the uterus?

There is more than one way to remove endometrial polyps. Each of them has its own disadvantages and advantages. Below is a description of each method, its features, as well as its pros and cons.

The most outdated method, which is used less and less, is removal using open abdominal surgery. This method does not require specific equipment, so it is widely used in medical institutions that do not have enough funding to purchase high-tech equipment that is required for other, more modern methods. Nevertheless, it continues to confidently save the health, and even the lives of many patients.

During this operation, a complete incision is made in the abdominal wall, all muscle layers, the uterus itself, after which the polyp is removed. Then all layers are sutured. Naturally, this method is highly traumatic. During the operation, all layers and tissues are damaged. A long period of time is required for their complete restoration. The risk of complications increases many times: prolonged bleeding, damaged tissue. Against the background of a violation of the integrity of the membranes, an infectious process can develop.

No less dangerous is curettage, in which the uterine cavity is blindly scraped out, cutting off polyps. Most often used in cases of multiple polyps. A serious disadvantage is that this method is often accompanied by relapses. Polyps tend to form again if a stalk or part of the tissue remains. And this probability is very high, since the doctor may not notice part of the polyp during the operation.

If it remains, there will be active recovery, and after some time it will form again. There is a risk that the damaged cell will undergo malignancy, which will create the basis for further formation of a cancerous tumor. Today, this method is still used, but they try to perform it under the control of a hysteroscope, which allows you to see the entire cavity and walls of the uterus, the image is visualized on the screen. With this method of performing the operation, it will be less traumatic.

A less dangerous method is laparoscopy. This method does not involve a cavity incision. Skin punctures are made in the places where the polyp is located. Special equipment, a laparoscope, is inserted through them. First, the cavity is examined using a small video camera inserted through a tube. This allows the doctor to assess the condition of the endometrium, examine the polyp, and assess the scale of the operation. Then, surgical instruments are inserted through another tube, which makes it possible to precisely remove the polyp, while monitoring the process using a video camera. This method is less painful, there is no severe tissue damage, so recovery is quick, and complications are rare.

The hysteroscopy method is considered the safest. The operation is performed by opening the cervix using special dilators, using a hysteroscope. At the end of this device there is a camera, with which the doctor examines the entire uterine cavity and determines the further course of the operation. Having noticed a polyp, the doctor removes it using an electric loop, which makes it possible to cut it off completely, under the stalk. The cut site is cauterized with liquid nitrogen or 5% iodine tincture, which helps prevent relapses, and is also a reliable prevention of infection and inflammation.

The operation is painless and fast (it takes an average of 15-20 minutes). It can be performed not only under general anesthesia, but also under local anesthesia. The method is chosen by the anesthesiologist, based on many parameters, including the patient's condition, the severity of the disease, and the scope of surgical intervention. This procedure is recommended to be performed 2-3 days after the end of menstruation, since it is during this period that the uterine mucosa becomes as thin as possible and the polyp rises above the surface. It is easily removed at this time.

Also, many clinics remove polyps using a laser. This is a method that allows for the most precise and targeted removal of a polyp without damaging the surrounding tissues. This is a gentle method that practically does not damage the uterus and does not leave scars. Therefore, it can be used even by women who have not given birth and are still planning to have children. The laser allows for the removal of a polyp layer by layer. The doctor can precisely control the depth to which the laser beam penetrates. Due to the removal using a beam, there is no impact on the possibility of fertilization of the egg.

How long does it take to remove an endometrial polyp?

On average, the manipulation takes about 30 minutes.

Removal of glandular polyp of the endometrium

A glandular polyp is a formation formed by glandular cells. They tend to grow if left untreated. Hysteroscopy is most often used for removal, since such polyps are removed fairly quickly as soon as they are hooked under the stalk. In addition, this method makes it possible to visualize the polyp well and prevent the likelihood of relapse by removing the polyp completely, including the vessels that feed it.

Hysteroscopy and hysteroresectoscopy of endometrial polyp

They are based on the use of specific equipment and a mini video camera. With the help of these tools, it is possible to detect, examine and remove a polyp with maximum accuracy. This operation is quite simple, does not require surgical access, since access to the polyp is carried out naturally - through the cervical canal.

Surgical instruments are inserted through the hysteroscope tube. The polyp is removed under camera control using special scissors and forceps. Removal is performed precisely and accurately, by separating the polyp stalk from the uterine wall. It is important to completely remove the stalk, because if it is not completely removed, the polyp will grow again.

The method also has its advantages, as it allows visualization of existing pathologies by displaying the image on the screen. The image is enhanced by introducing a contrast agent.

Another advantage is that the risk of damage is practically absent, and short-term anesthesia is used. This type of surgical intervention is minimally invasive, so the risk of damage and bleeding is practically absent. Due to the absence of an abdominal incision, the recovery process is significantly accelerated. This operation does not require mandatory hospitalization. If everything goes well and without complications, the woman is sent home on the same day. It is important that there is no scar left on the uterus, so the operation does not affect the woman's ability to bear and give birth to a healthy child.

Due to the absence of peritoneal incisions and low degree of damage to surrounding tissues, the operation is well tolerated and can also be performed after abortions, childbirth, and other gynecological interventions. It is often used to remove the remains of the fertilized egg and placenta.

Resectoscopy of endometrial polyp

The method has certain similarities with the hysteroscopy method. The difference is that the removal is performed using a resectoscope, which is a special loop for removal.

The procedure looks something like this: the patient is put under anesthesia, then antiseptic treatment is performed. Dilators are inserted into the cervical canal. They allow the canal to be widened and a hysteroscope to be inserted. A special liquid is injected into the cavity to straighten the walls of the uterus. A resectoscope loop is inserted through the hysteroscope tube. The hysteroscope allows the progress of the operation to be monitored, since it contains a camera that visualizes the entire area being operated on.

Endometrial polyp curettage

This is an outdated method in which the uterine cavity is scraped with a special sharp instrument (curette).

Preparation for endometrial polyp curettage. Today, curettage is performed after diagnostic hysteroscopy, which allows the doctor to examine and remember the location and structural features of the polyp.

Laser removal of endometrial polyp

The laser is one of the safest methods, allowing to remove it with maximum precision. This is a targeted method, which does not damage the surrounding tissues, and it is also almost impossible to get injured. The advantage is that the laser does not leave scars on the cervix, as a result of which the method does not affect the reproductive function of a woman. Accordingly, it can be applied to women who are still planning to have children, which is important in gynecology.

There are no scars or marks left, the risk of complications, infection, bleeding is excluded. Laser removal of polyps is considered the most effective and safe method. It allows the polyp to be removed layer by layer.

It is also important that laser removal does not require further hospitalization of the patient. The procedure lasts no more than 2-3 hours on average, after which the woman should be under the supervision of a doctor for some time, and if she feels well, she can immediately go home. Recovery occurs very quickly, the woman may not even take sick leave. However, it is necessary to attend routine examinations.

Removal of endometrial polyp by radio wave method Surgitron

The impact is based on the use of radio wave radiation. High-energy radio waves are used, which have a restorative effect on the body. The procedure is quite fast and painless. Relapses do not occur, because additional thermal treatment of the operated area is used. This virtually eliminates the possibility of an electrical burn.

In all the years of practice, such a case has not been recorded. The method is good because it does not leave scars, does not damage the mucous membrane. Recovery after surgery occurs over a period of 3 weeks to several months. Any polyps are an indication for the procedure, if they are benign. After the procedure, mandatory coagulation is carried out. It is worth noting that the procedure is so painless that it is carried out without anesthesia.

Cauterization of endometrial polyp

Immediately after the operation, the site of polyp removal is cauterized, which prevents the polyp from growing again and prevents bleeding. In some cases, if the polyps are small enough, they can be cauterized without being removed. Liquid nitrogen or an alcohol solution of iodine are used for cauterization.

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Contraindications to the procedure

In case of inflammation of the appendages caused by both external infection and internal autoflora. In case of latent infection, venereal diseases, it is necessary to first get rid of the infection. In particular, chlamydial infection is a direct contraindication.

The operation is also contraindicated in the presence of vaginal dysbacteriosis, candidiasis, heavy bleeding from the genitals, especially if the cause is endometriosis, hyperplasia, tissue edema. In case of bleeding, the operation is postponed until the bleeding stops. Polyps are also not removed during pregnancy.

The operation cannot be performed if there are pathological phenomena in the cervix, especially if they prevent the normal passage of the hysteroscope into the uterine cavity (these can be neoplasms, cancerous tumors, scars on the uterus, left after childbirth or operations). The operation is also contraindicated in the presence of severe concomitant pathologies.

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Care after the procedure

Depending on the technique of the operation, recovery after removal of the endometrial polyp lasts from 5 to 90 days. In the period after the operation, physiological discharge is observed for 2-5 days. These are the consequences of trauma, which inevitably occurs, even with the most careful removal.

In the postoperative period, rehabilitation therapy is often carried out to prevent re-growth. This is due to the fact that regardless of the method used to perform the operation, there is always a risk that the polyp will grow again. The reason is the remnants of cells that could not be scraped out during the operation. Even one cell can provoke re-growth of the polyp. The risk is especially high when performing the operation using the scraping method.

Treatment with anti-inflammatory drugs is used. This is due to the fact that any manipulation entails tissue damage, disruption of the natural microbiocenosis, as a result of which the likelihood of inflammation and infection is significantly reduced.

In case of an infectious process, as well as if curettage was performed, a bacteriological study is prescribed to identify the pathogen and then select an antibacterial agent that exhibits maximum activity against it. Inflammation is stopped in a short time so as not to provoke re-growth of the polyp. In case of dysbacteriosis, probiotic drugs can be prescribed.

The removed polyp is always examined by histological methods to determine whether the tumor is benign or malignant. If a malignant tumor is detected, additional antitumor treatment may be required. In case of hormonal imbalance, hormonal therapy is performed.

What should you not do after endometrial polyp removal?

After the operation, you cannot eat heavy food, expose yourself to stress, overexertion, or overfatigue. You cannot walk for a long time or get too cold. However, you cannot take a hot bath, visit saunas or baths either. This can cause bleeding. Only taking a shower is allowed.

For a month, you cannot play sports or do physical exercise. You should abstain from sexual activity for the same period. For a month, you cannot do douches or take medications that thin the blood, including analgin and aspirin.

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