Hysteroscopic Endometrial Polyp and Fibroid Removal: Cold Knife vs. Hot Knife

Hysteroscopic Endometrial Polyp and Fibroid Removal: Cold Knife vs. Hot Knife

【Hysteroscopy Classroom】

💡 Endometrial polyps and fibroids are important lesions that can cause abnormal menstrual bleeding and infertility, affecting about 20–30% of gynecologic patients.

📌 Diagnosis and treatment mainly rely on ultrasound and hysteroscopy.

Surgical removal is especially recommended for polyps or fibroids larger than 1 cm, or those causing symptoms.

Below is a comparison of the main surgical methods for polyp removal:

1️⃣ Electrosurgical resection, hot knife

This method uses electrical heat energy to cut and remove the polyp. Its advantage is more complete removal.

However, the heat effect may damage nearby healthy endometrium, increasing the risk of poor endometrial healing and regeneration.

• Suitable for those without fertility needs
• Relatively lower cost, with moderate procedure time
• Side effects: increased risk of postoperative adhesions, and possible menstrual abnormalities or infertility

2️⃣ Standard cold knife, loop knife or grasping forceps

This method uses manual instruments to remove the polyp. It causes minimal thermal damage to the endometrium and is suitable for patients who require better endometrial protection.

• The disadvantage is that it takes more time, especially for larger or multiple polyps
• Advantage: avoids thermal effects and allows better postoperative healing

3️⃣ TruClear cold knife, hysteroscopic tissue removal system

This method uses specialized cold knife instruments to cut polyps or fibroids into pieces and suction them out.

Because it is fast and causes minimal damage to the endometrium, it is currently the preferred option for women who have fertility needs.

• Precision instruments shorten surgery time by about 1/2 to 2/3
• Disposable instruments are more expensive, about NT$40,000–50,000
• Advantages: best preservation of postoperative endometrial integrity, and the lesion can be completely collected for pathological examination

👨🏻‍⚕️ Selection recommendations ‼️

• For those with fertility needs
Cold knife methods are strongly recommended to avoid endometrial damage caused by electrosurgery.

• For those without fertility needs
Either electrosurgical resection or cold knife methods may be considered. You can discuss with your physician and choose the appropriate method based on medical recommendations and financial considerations.

• For submucosal uterine fibroid removal
Because fibroid tissue is harder, self-paid cold knife treatment is recommended. It can remove the lesion quickly while avoiding thermal injury.

👨🏻‍⚕️ In addition ‼️

1. Recurrence and follow-up treatment
   After removal of endometrial lesions, regular follow-up is recommended. The recurrence rate is about 20–50%, depending on severity, region, genetic factors, and other conditions.
2. Pregnancy rate after surgery
   Polyp removal can significantly improve the chance of pregnancy. For mild lesions, the pregnancy rate may reach 70%; for moderate lesions, it is about 40–50%.
3. Importance of endometrial protection
   Especially for women of reproductive age, avoiding excessive scraping of normal endometrium during surgery is crucial for future fertility.

Yun-I wishes your dreams come true!