Hysteroscopic polypectomy– New approaches

Mahantesh KaroshiConsultant Gynaecologist

Royal Free London NHS Foundation Trust

Barnet Hospital

London, UK

• 33% of GOPD attendance are AUB related

• Of these, 10-30% will be due to endometrial polyps

• In 10% of women with PMB, endometrial cancer is the causative factor

Scale of the problem

Existing technique- Monopolar hysteroscopic resection

The current model of care at BCFH

The proposed model of care

NICE-2013

Product comparison

Truclear Vs Myosure

Polyp Myosure

Current Care Model

Proposed Model of Care

Cost Effectiveness (1)

 Running Cost per Procedure

Reimbursement per Procedure

TRUCLEAR Cost

Profit/Loss Per Procedure

Number of Procedures per year

Profit/Loss per year

             

Theatre: Polypectomy £700 £893   £158 450 £71,100

Outpatient: Polypectomy £150 £1,197 £296 £716 450 £322,327

Obstet Gynecol -2014

RCT study conclusions

• Feasible and safe

• Quicker (5mins Vs 10mins)

• Less painful

• Increased complete removal (98% vs 83%)

• Truclear– less complex movements.

– Simultaneous cutting and removal of chips

– Mechanical cutting less irritating than electrical cutting

TRUCLEAR vs. Myosure

 MyoSure Lite   

TRUCLEAR INCISOR Plus Blade 2.9 

Scope diameter 6.25mm 5.0mm without sheath 5.6mm with sheath

Blade diameter 3.0mm 2.9mm

Visualization • Rod lens hysteroscope

• Blade-only outflow

• Fiber optics hysteroscope

• Continuous outflow – blade and sheath

Fluid Management System

• Aquilex Fluid System

• Cost per procedure £70

• Bag on a pole• Cost per

procedure £5

Thank you

Do not expect different results if you are doing the same thing over and over again