Approach to abnormal uterine bleeding in presence of endometrial polyps with new hysteroscopic devices

Purpose: To compare different endoscopic techniques, such as hysteroscopy with morcellator and traditional resectoscopy, and different surgical settings, such as operating room setting and outpatient setting, for patients with abnormal uterine bleeding (AUB) and suspected endometrial polyps. Metho: In this prospective study, 180 women diagnosed with endometrial polyps on ultrasound were enrolled. Patients were divided into three groups: 1) resectoscopy under anesthesia in an operating room setting; 2) morcellation with anesthesia in an operating room setting; and 3) outpatient morcellation without anesthesia. The main outcomes included procedure completion rates, operative time, patient satisfaction, and pain intensity using the Visual Analog Scale (VAS). Additionally, histological analysis was conducted for all cases. Results: Among the 180 patients, all procedures were completed in Groups 1 and 2, while Group 3 had a 96.7% completion rate. Procedure duration was the shortest in Group 3 (average 6.5 min), significantly less than in Group 1 (p value < 0.05; CI 95%). Pain was manageable in all groups, with VAS scores < 4 for most patients in the outpatient setting. Histology confirmed benign polyps in most cases, and malignant or premalignant conditions were around 3% of procedure. Conclusion: Outpatient “see-and-treat” hysteroscopy with morcellator, performed without anesthesia, proved feasible, safe, and cost-effective, with minimal discomfort and comparable diagnostic accuracy to traditional methods. This technique offers a practical approach for the management of AUB, enabling efficient treatment while reducing costs and resource usage, and may be considered as a preferred option in appropriate patients.