In general, it is recommended to excise any symptomatic polyp. If the polyps are asymptomatic, it seems appropriate to simply keep an expectant management, with serial ultrasound scans every 6 months to monitor their growth.
The technique for hysteroscopic polypectomy varies depending on the size of the polyp and the available hysteroscope. It is important to emphasize that endometrial polyps are growth areas derived from the endometrium, they DO NOT invade the myometrium.
1- Mechanical hysteroscopic polypectomy is performed with hysteroscopic scissors or biopsy forceps. This modality is often used for small polyps and can be done in the office setting.
2-Hysteroscopic polypectomy with Versapoint® bipolar electrosurgery which allows cutting the base of the polyp. It is frequently used in cases of large polyps, they could be fragmented into small pieces facilitating the extraction.
3-Resectoscopic polypectomy: It requires cervical dilation. It is usually reserved for large polyps, often performed in the operating room under general anesthesia.
4-Polyps morcelator: new generation of devices that enable the fragmentation and ease extraction of the polyps.