uterine polyps: modern management
TRANSCRIPT
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