Chapter 235 Cervical Polypectomy

DESCRIPTION

Cervical polypectomy is the removal of cervical or visible endocervical polyps; it is generally a simple, painless office procedure.

INDICATIONS

Cervical or visible endocervical polyp.

CONTRAINDICATIONS

Known or suspected allergy to the agents used, coagulopathy. Relative: pregnancy.

REQUIRED EQUIPMENT

• Skin (vaginal) preparation materials (iodine-based antibacterial solution [e.g., Betadine] or other suitable cleansing agents)

• Sterile or examination gloves

• Vaginal speculum

• Sponge stick or uterine packing forceps (fine scissors may be used but are seldom required)

• Kevorkian or similar endocervical curette

• Monsel solution or paste (ferric subsulfate) or silver nitrate–tipped sticks

• Histology fixative (10% formalin) in container

TECHNIQUE

The polyp is first visualized through the use of a standard vaginal speculum. Disinfection with a suitable solution may be performed, although most believe it is not required. The visible portion of the polyp is then grasped, and gentle traction, twisting through several revolutions, or excision accomplishes removal of polyp. If the polyp is thought to arise from high in the endocervical canal, the base may be gently curetted with an endocervical curette. Curettage of the endocervical canal should also be considered to rule out a coexisting hyperplasia or cancer. Although malignancy is rare, all polyps should be submitted for histologic examination. The base of the polyp may be treated with chemical cautery (Monsel solution or silver nitrate), electrocautery, or cryocautery.

COMPLICATIONS

Bleeding.

FOLLOW-UP

Although the histology of the polyp should be confirmed as benign, malignant degeneration of an endocervical polyp is extremely rare. The reported incidence is less than 1 in 200.

CPT CODE(S)

58999 Unlisted procedure, female genital system (nonobstetric)

REFERENCES

Level II

Amesse LS, Taneja A, Broxson E, Pfaff-Amesse T. Protruding giant cervical polyp in a young adolescent with a previous rhabdomyosarcoma. J Pediatr Adolesc Gynecol. 2002;15:271.

Khalil AM, Azar GB, Kaspar HG, et al. Giant cervical polyp. A case report. J Reprod Med. 1996;41:619.

Pradhan S, Chenoy R. Dilatation and curettage in patients with cervical polyps: a retrospective analysis. BJOG. 1995;102:415.

Level III

Katz VL. Benign gynecologic lesions. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:436.