Background: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix.
Methods: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisfaction were assessed with a Visual Analogue Scale (VAS).
Results: Operative time was significantly longer in group A than in group B (18.3±7.4 vs. 11.3±5.2 minutes), the cumulative complication rate and the need of postoperative analgesics were higher in group A than in group B. VAS of surgical difficulty and surgeon's satisfaction were higher in group B than in group A.
Conclusions: The small-diameter hysteroscopy is a safe and effective approach for endometrial polyp up to 4 cm in patients with unfavorable cervical canal at risk of cervical injury.