Removal of the endometrial polyp

Today, the most common problem in gynecological practice, are polyps. Removal of the endometrial polyp is a compulsory procedure, because otherwise it is impossible to get rid of them. And they need to be removed as soon as possible, as they grow into a tumor.

Polyps are benign in nature, which affects the inner walls and uterine cavity (endometrium). In themselves, they are a consequence of the proliferation of the endometrium, formed by the uterine membrane. In most cases, they are attached to the wall of the uterus with a special leg. Using modern equipment, polyps can be removed quickly, without the consequences and risk of re-growth.

How urgent it is to remove the endometrial polyp?

Polyps of the endometrium should be removed as quickly as possible, since it has the property of expanding, and undergoing transformation into a malignant tumor. Any surgical treatment can be effective only at an early stage of pathology detection.

Preparation

It is important not to live a sexual life about a week before the operation, or, in extreme cases, it is necessary to use a condom. Also it is not recommended to use any means, especially antibacterial agents, which will help to preserve the natural state of the microflora. It is also better not to use any medications, cosmetics.

A week before the operation, it is better to stick to dietary nutrition. In food you can not eat fried, sharp, smoked dishes. It is better to give preference to boiled and steam dishes with a minimum content or complete absence of seasonings, spices.

What tests are needed for hysteroscopy of the endometrial polyp?

When preparing for the procedure for the removal of polyps, it is necessary to pass a number of tests and undergo a survey. Based on these studies, a decision will be made on the expediency of removing the polyp. The doctor will be able to choose the best method of removal, and the anesthesiologist will determine the most suitable variant of anesthesia.

During the gynecological examination, the cervix is examined in the mirrors. This is important, because during the operation it will be through the channel that tools will be introduced and all the necessary manipulations will be made.

Compulsory bacapsis is performed to exclude the risk of infection of the uterus, cytological examination. An electrocardiogram is necessary, which will allow to assess the condition and mode of the heart. This will allow you to assess how the load will affect the operation of the heart, as well as choose the best anesthesia.

From instrumental studies, transvaginal ultrasound is required, which makes it possible to examine the uterus. From laboratory tests, a clinical analysis of blood and urine, a study of hidden infections, must necessarily take place. Also a prerequisite is the availability of the results of fluorography and consultation of the therapist.

[1], [2]

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

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

Anesthesia in the removal of the endometrial polyp

Often patients are left for inpatient treatment. The duration of hospitalization is usually small, but anesthesia is required. His choice of a doctor based on age and the presence of concomitant diseases. The drugs must meet the basic requirements - to be safe and reliably anesthetize. The most commonly used intravenous route of anesthesia.

[3], [4], [5], [6], [7]

Removal of the endometrial polyp under anesthesia

It is removed under anesthesia. The choice of the method of anesthesia is determined and selected by an anesthesiologist individually. With relatively good health and short duration of manipulation, it is recommended to replace general anesthesia with spinal anesthesia. Endotracheal anesthesia is also used.

Technique of the removal of the endometrial polyp

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

The traditional method of removal is the usual cavity 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 obsolete. Moreover, it is established that it is dangerous, and carries many risks. So, the recovery takes a long time, the risk of bleeding increases. The operation is rather complicated, it takes a very long time. The main difficulty is that you need to consistently cut all the overlying layers, as well as the uterus itself, make the necessary manipulations to remove the polyp, sew all layers.

A safer method is hysteroscopy: it is widely used in practice. This method is considered to be low-traumatic, making the floor a mild anesthesia, which lasts only 15-20 minutes. The essence of the method is that the polyp is removed without producing any incisions. All necessary manipulations are carried out naturally, through the opening of the cervix by special instruments (hysteroscope). When applying this method, the recovery occurs quickly enough, the same day the woman can go home.

One of the subspecies of hysteroscopy is scraping, which is performed under the control of a hysteroscope. But this method is also obsolete, and is practically not used at present, because it is highly traumatic, and often leads to serious disruption 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 with a special instrument - a laparoscope. In order to remove the polyp laparoscopically, you need to make a small laparoscopic access.

In fact, several punctures are made on the ventral side in the abdominal region. Through this puncture, a laparoscope is first introduced - a tool that is equipped with a camera at the end. It allows to examine the operated cavity, to develop tactics of operation. Then through another incision, surgical equipment is introduced, through which I remove the polyp. Recovery is very fast, as the surrounding tissues are practically not damaged. There are almost no scars, postoperative pain also does not disturb much.

How is the endometrial polyp removed in the uterus?

There is no one way to remove the polyp of the endometrium. Each of them has its own shortcomings, as well as its advantages. Below is a description of each method, its features are considered, plus the pros and cons.

The most obsolete method, which is used increasingly rarely, is removal with the help of an open cavity operation. This technique does not require specific equipment, therefore 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, she continues to confidently save health, and even the lives of many patients.

During this operation, a complete cut of the abdominal wall, all muscle layers, the uterus itself is made, after which the polyp is removed. Then all the layers are sewn. Naturally, this method is highly traumatic. During the operation, all layers and tissues are damaged. It takes a long period of time to fully recover. The risk of complications increases many times: prolonged bleeding, damaged tissue. Against the background of violation of the integrity of the shells, an infectious process can develop.

No less dangerous is scraping, in which the uterine cavity is scraped blindly, cutting off the polyps. It is most often used in the case of the formation of multiple polyps. A serious drawback is that this method is often accompanied by relapses. Polyps tend to form again if the leg or part of the tissue remains. And such a probability is very high, since the doctor during the operation may not notice a part of the polyp.

If he remains, active recovery will take place, and after a while he will form again. There is a risk that the damaged cell will undergo malignancy, which will form the basis for the further formation of a cancerous tumor. Today this method is still used, but it is tried to perform under the control of a hysteroscope, which allows to see completely the entire cavity and the walls of the uterus, the image is visualized on the screen. With this method of carrying out the operation, it will be less traumatic.

Less dangerous is the method of laparoscopy. With this method, a cutaneous incision is not done. Skin punctures are produced in the places where the polyp is located. Through them, special equipment is introduced - a laparoscope. First, the cavity is inspected with a small video camera, which is inserted through the tube. This gives the doctor an opportunity to assess the condition of the endometrium, examine the polyp, and evaluate the scale of the operation. Then through the other tube surgical instruments are introduced, which makes it possible to accurately remove the polyp, while controlling the process with a video camera. This method is less painful, strong tissue damage is not observed, so recovery is rapid, complications are rare.

The method of hysteroscopy is considered the safest. The operation is performed through the opening of the cervix using special expanders, using a hysteroscope. At the end of this device is a camera, through which the doctor examines the entire cavity of the uterus and determines the further course of the operation. Noticing the polyp, the doctor removes it with an electric loop, which makes it possible to cut it completely, under the foot. The site of the cut is cauterized with liquid nitrogen, or 5% iodine tincture, which helps prevent relapse, and is a reliable prevention of infection and inflammation.

The operation is painless, fast (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 an anesthesiologist, based on many parameters, including the patient's condition, the severity of the disease, the amount of surgical intervention. This procedure is recommended for 2-3 days after the end of menstruation, because it is during this period that the uterine mucosa becomes as thin as possible and the polyp rises above the surface. It is easy at this time to be deleted.

Also in many clinics polyps are removed using a laser. This is the method that allows you to accurately and accurately remove the polyp, without injuring the surrounding tissues. This sparing method, which practically does not damage the uterus, does not leave scarring. Therefore, it can be applied even to nulliparous women who are still planning to have children. The laser makes it possible to remove the polyp layer by layer. The doctor can clearly control the depth at which the laser beam penetrates. Due to the removal by the beam, there is no effect on the possibility of fertilization of the oocyte.

How long does the removal of the endometrial polyp?

The average manipulation takes about 30 minutes.

Removal of glandular polyp of the endometrium

The glandular polyp is a formation that is formed by glandular cells. They tend to sprout if they are not treated. For removal, the method of hysteroscopy is most often used, since such polyps are quickly removed as soon as they are hooked under the foot. In addition, this method makes it possible to clearly visualize the polyp, and to prevent the occurrence of a relapse, removing the polyp completely, including the vessels that feed it.

Hysteroscopy and hysterosectoscopy of the 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 discover, investigate the polyp with maximum accuracy and remove it. This operation is simple enough, does not require immediate access, since access to the polyp is carried out naturally - through the cervical canal.

Surgical instruments are inserted through the hysteroscope tube. The polyp under the control of the chamber is removed by means of special scissors and forceps. Removal is carried out accurately and accurately, by separating the leg of the polyp from the wall of the uterus. It is important to completely remove the leg, since if it is not removed completely, the polyp will re-grow.

Also, the method has its advantages, as it makes it possible to visualize existing pathologies by displaying an image on the screen. The image is enhanced by the introduction of a contrast medium.

Another advantage is that the risk of damage is almost non-existent, anesthesia is used short-term. This type of surgery is minimally invasive, so the risk of damage, bleeding, is virtually nonexistent. Due to the absence of abdominal incision, the process of recovery is significantly accelerated. Such an operation does not imply mandatory hospitalization. If everything went smoothly and without complications, the woman is released home the same day. It is important that the uterus does not leave a scar, so the operation does not affect the ability of a woman to bear and give birth to a healthy child.

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

Resectoscopy of the endometrial polyp

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

The procedure looks like this: the patient is anesthetized, then antiseptic treatment is performed. Expanders are introduced into the cervical canal. They allow you to expand the channel and enter a hysteroscope. To spread the walls of the uterus, a special liquid is introduced into the cavity. A loop of the resectoscope is inserted through the hysteroscope tube. The hysteroscope allows you to monitor the progress of the operation, since it contains a camera, through which the entire surgical site is visualized.

Scraping endometrial polyp

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

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

Removal of the endometrial polyp by the laser

The laser is one of the safest methods to remove it as accurately as possible. This is an aiming method, in which the surrounding tissues are not damaged, it is also impossible to get an injury. The advantage is that the laser does not leave scars on the neck, as a result of which the method does not affect the reproductive function of the woman. Accordingly, it can be applied to women who are still planning to have children, which is important in gynecology.

Scars and traces do not remain, the risk of complications, infection, bleeding is excluded. Removal of polyps by laser is considered the most effective and safe way. It allows you to delete a polyp layer by layer.

It is also important that laser removal does not require further hospitalization of the patient. The procedure on average lasts no more than 2-3 hours, after which the woman must stay for some time under the supervision of a doctor, and with a satisfactory state of health, can immediately go home. Recovery is very fast, a woman may not even take a sick leave. Nevertheless, it is necessary to attend routine inspections.

Removal of the endometrial polyp by the radio-wave method of the sargitron

At the heart of the impact is the use of radio wave radiation. High-energy radio waves are used, which have a restoring effect on the body. The procedure is fast enough, painless. Relapses do not occur, because additional thermal treatment of the operated site is applied. In this case, the probability of obtaining an electric burn is virtually eliminated.

For all the years of practice, no such case has 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. Indications for the exercise are any polyps, 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 the endometrial polyp

Immediately after the operation, the place of removal of the polyp is cauterized, which avoids the re-growth of the polyp, prevents bleeding. In some cases, if the polyps are small enough, they can be burned without removing. For cauterization use liquid nitrogen, or an alcohol solution of iodine.

[8], [9], [10], [11], [12], [13]

Contraindications to the procedure

With inflammation of the appendages caused by both external infection and internal autoflora. If there is a hidden infection, venereal diseases, you must first get rid of the infection. In particular, chlamydial infection serves as a direct contraindication.

Also, the operation is contraindicated in the presence of vaginal dysbiosis, candidiasis, the presence of heavy bleeding from the genital organs, especially if it is caused by endometriosis, hyperplasia, swelling of the tissues. In case of bleeding, the operation is postponed until the bleeding stops. When pregnancy, polyps are also not removed.

It is impossible to carry out the operation in the presence of pathological phenomena in the cervix, especially if they interfere with the normal passage of the hysteroscope into the uterine cavity (these can be neoplasms, cancerous tumors, scars on the uterus, the remaining field of labor or operations). Also, surgery is contraindicated in the presence of severe accompanying pathologies.

[14], [15], [16], [17], [18], [19], [20]

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 for 2-5 days, physiological segregations are observed. This is the result of a trauma that inevitably occurs, even with the most careful removal.

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

Anti-inflammatory drugs are used. This is due to the fact that any manipulation entails tissue damage, a violation of the natural microbiocenosis, resulting in a significant decrease in the likelihood of inflammation, infection.

In the case of an infectious process, and also if a scraping was performed, a bacteriological study is carried out to identify the pathogen and further selection of an antibacterial agent showing maximum activity against it. Inflammation is stopped in a short time, so as not to provoke a repeated growth of the polyp. With dysbiosis, probiotic drugs may be prescribed.

The removed polyp is always examined by histological methods to determine if the tumor is benign or malignant. If a malignant tumor is found, additional antitumor treatment may be required. With hormonal imbalance, hormone therapy is used.

What can not be done after removal of the endometrial polyp?

After the operation, you should not eat heavy food, subject yourself to stress, overexertion, overwork. It is impossible to walk for a long time, to be supercooled. Nevertheless, to take a hot bath, to visit saunas and baths too it is impossible. This can cause bleeding. Only the shower is allowed.

During the month, you can not exercise, exercise. You should abstain from sexual activity for the same period. Within a month you can not do syringing, take medications that promote blood thinning, including analgin, aspirin.

[21], [22]