Role of surgical vaginoscopy through no-touch hysteroscope in the treatment of female reproductive polyps.

Abstract

Background: The study aims to investigate the application of surgical vaginoscopy via a no-touch hysteroscopic approach for the management of female genital polyps. The primary objective is to assess the feasibility of this technique in treating intrauterine pathologies in both pregnant and non-pregnant women.

Methods: A total of forty-six patients diagnosed with genital polyps underwent operative vaginoscopy at a university-affiliated hospital between April 1, 2017 and May 31, 2023. A retrospective analysis was conducted on the collected data, encompassing patient complaints, clinical presentations, surgical outcomes, and pathological diagnoses. Additionally, the success rate of the vaginoscopic procedures was determined.

Results: Forty-six patients with an average age of 33.0 ± 8.8 years were included in this study. Among them, 25 were non-pregnant (3 with and 22 without a sexual history). The most common clinical manifestation was irregular vaginal bleeding (11/25, 44%) followed by conscious vaginal protrusion (10/25, 40%). Among the 21 pregnant patients, the main symptom was irregular vaginal bleeding during pregnancy (100%). The postoperative pathological diagnoses included 11 endometrial polyps, 33 cervical polyps, 1 multiple vaginal polyps, and 1 vaginal stump polyps. The coincidence rate between the intraoperative vaginoscopic diagnosis and postoperative pathological diagnosis was 100%. Among the non-pregnant patients, 11 were diagnosed with endometrial polyps, with an average length of 2.2 ± 1.2 cm, 1 patient had vaginal residual polyps after total hysterectomy, with a polyp length of 0.3-0.7 cm, and 1 had multiple vaginal polyps, with a length of 0.5-3 cm. Twelve patients had cervical polyps with an average length of 3.4 ± 1.2 cm. Twenty-one pregnant patients were diagnosed with cervical polyps, the average length of 2.4 ± 1.4 cm. All patients successfully underwent vaginoscopic surgery, for an average surgical duration of 23.5 ± 14.9 min, a bleeding volume of 1-10 mL(4.5 ± 3.4 mL), and an average hospitalisation of 2.7 ± 1.3 days. Throughout the surgical procedures, no complications were encountered, including water intoxication or uterine perforation. Postoperatively, no patients experienced discomforts such as fever or moderate to severe abdominal pain. Furthermore, all non-pregnant women were monitored for a two-month period following surgery, and throughout this interval, there were no reports of abnormal vaginal bleeding, unusual vaginal discharge, or abdominal pain. None of the 21 pregnant women experienced abnormal vaginal bleeding after the surgery. Nineteen of them delivered at full term, and one underwent caesarean delivery at 31 weeks owing to placental abruption. All the newborns had Apgar scores of 10, 10, and 10, and one had a miscarriage at 18 weeks of gestation.

Conclusion: Vaginoscopic surgery through no-touch hysteroscope represents a minimally invasive and highly effective method for addressing female reproductive tract polyps. This approach holds significant clinical value, particularly in the management of cervical polyps during pregnancy.