Improved Hysteroscopic Resection of Endometrial Polyps Using 6-Fr Micro-Scissors and Forceps

Our research is mainly about reproductive hysteroscopy, and the main problem we want to solve is how to ensure that the uterine environment of infertile patients achieves optimal pregnancy conditions. The main challenge now is how to completely remove endometrial polyps while protecting the patient's fertility and not damaging the basal layer of the endometrium. Our surgical protocol can ensure the total removal of polyps and at the same time, maximize the patient's endometrial receptivity in order to improve the patient's fertility.

To begin, place the anesthetized patient in the lithotomy position and secure the lower legs with bandages on both sides. With the help of an anesthesiologist, establish peripheral venous access on the patient, then assemble the hysteroscope lens, adjust the focus and set the white balance. Set the hysteroscope pressure at 100 millimeters of mercury and a flow rate of 300 milliliters per minute, using 0.9%saline as the distension medium.

Using cervical forceps, grasp the lower right lip of the cervix and perform iodine disinfection for the vagina, fornix and cervix. Introduce the hysteroscope into the uterine cavity through the cervical canal. Perform cervical dilation using Hegar dilators ranging from number 3.5 to number 5.5.

To begin polyp removal, for patients with a single uterine polyp, use the blunt end of the micro forceps to pinpoint the basal layer of the endometrium. Place the forceps in the anatomical gap between the endometrial polyp and the basal layer to grasp the basal portion of the endometrial polyp. Swiftly withdraw the micro forceps to ensure complete separation of the polyp base from the endometrial base.

Collect the excised polyp tissue for pathological examination. To remove multiple endometrial polyps, use micro scissors to excise most of the polyps to increase the surgical space and enhance visibility within the operative field. Then, remove any remaining polyp bases as demonstrated previously.

Now, start the polyp excision sequence with the posterior uterine wall, followed by the uterine lateral wall and corners, and then the anterior uterine wall.