Cervical Polyp Removal in India and UAE | Complete Patient Guide

• Symptomatic patients experiencing abnormal uterine bleeding (post-coital, intermenstrual, or postmenopausal bleeding) attributable to a visualised cervical polyp on speculum examination or TVUS

• Patients with an incidentally discovered cervical polyp on ultrasound or colposcopy, particularly polyps >1 cm in diameter or those with irregular vascularity on colposcopic assessment

• Women with unexplained infertility or recurrent implantation failure where a cervical polyp is identified as a potential mechanical or inflammatory barrier

• Patients with abnormal or unsatisfactory Pap smear results co-existing with a visible polyp, requiring tissue sampling and concurrent removal

• Required pre-operative diagnostics: Liquid-based cytology (Pap smear / ThinPrep), transvaginal ultrasound (TVUS) with endometrial thickness measurement, office hysteroscopy or colposcopy for polyp mapping, full blood count (FBC), coagulation profile (PT/aPTT/INR), serum beta-hCG to exclude pregnancy, and STI/cervical infection screen (Chlamydia trachomatis, Neisseria gonorrhoeae) prior to instrumentation

• Patients with postmenopausal bleeding and a cervical polyp require endometrial biopsy (Pipelle or hysteroscopic-directed) to exclude concurrent endometrial pathology before or concurrent with polypectomy

• Relative contraindications: Active cervical or pelvic infection (must be treated and cleared before instrumentation), pregnancy (procedure deferred to postpartum period unless clinically urgent), active anticoagulation therapy without pre-operative bridging plan, known cervical stenosis requiring specialised dilatation approach

• Absolute contraindications: Confirmed or suspected cervical malignancy (requires oncological staging and formal excision procedure such as LLETZ/LEEP or cone biopsy rather than simple polypectomy)

Blind Avulsion (Twist-and-Pull Polypectomy): The traditional office-based technique involves grasping the polyp pedicle with ring forceps and rotating it until it detaches. Suitable only for pedunculated polyps with a narrow, clearly visible stalk located at or near the external os. This approach carries a higher risk of incomplete excision (residual pedicle), recurrence, and bleeding compared to hysteroscopic methods, and provides no visualisation of the endocervical canal. It remains acceptable for small (<1 cm), single, externally visible polyps in resource-limited settings but is no longer the preferred standard.

Office Hysteroscopic Polypectomy (Outpatient/Vaginoscopic Approach): Performed using a 3–5 mm diagnostic or operative hysteroscope with a continuous-flow system (normal saline or CO₂ distension medium), this technique provides panoramic visualisation of the endocervical canal and endometrial cavity. Polyps are excised using 5 Fr semi-rigid scissors, biopsy forceps, or a bipolar electrode system (Versapoint bipolar electrosurgery) that simultaneously cuts and coagulates the pedicle. The vaginoscopic (no-touch) technique — inserting the hysteroscope without speculum or tenaculum — significantly reduces patient discomfort and is standard practice at leading centres in India and the UAE. No general or regional anaesthesia is required in the majority of patients; paracervical block or NSAID pre-medication suffices.

Operative Hysteroscopy with Resectoscope or Morcellator (For Large or Broad-Based Polyps): Polyps exceeding 2–3 cm in diameter, broad-based sessile polyps, or multiple endocervical polyps may require a resectoscope (26 Fr) equipped with a monopolar or bipolar cutting loop, or an intrauterine morcellator system (e.g., Truclear, MyoSure) that mechanically cores and aspirates tissue under continuous hysteroscopic vision. The intrauterine morcellator is particularly advantageous as it retrieves intact tissue for histopathological analysis without thermal artefact and reduces operative time by 30–40% compared to conventional loop resection. This approach may require cervical dilatation under sedation or short general anaesthesia (total procedure time: 10–30 minutes).

LLETZ / LEEP or Cold-Knife Cone Biopsy (When Dysplasia is Suspected): If concurrent high-grade cervical intraepithelial neoplasia (CIN II/III) or early invasive disease is identified on colposcopy or biopsy, a large loop excision of the transformation zone (LLETZ/LEEP) or cold-knife conisation is performed rather than simple polypectomy. These procedures remove the transformation zone en bloc, providing a specimen for definitive histopathology and achieving oncologically adequate margins.

Post-Procedure Histopathology: Regardless of technique, all excised polyp tissue is submitted for formal histopathological analysis to identify endocervical adenocarcinoma in situ, cervical glandular intraepithelial neoplasia (CGIN), or other unexpected pathology. Results are typically available within 5–7 working days and are reviewed with the patient before discharge from the treating destination.

Step 1 — Pre-Travel Consultation (2–4 Weeks Before Departure): The patient shares existing investigation reports (Pap smear, TVUS, colposcopy images) with the assigned GAF Healthcare gynaecologist via secure teleconsultation. The specialist reviews findings, confirms procedural indication, requests any outstanding investigations (coagulation profile, STI screen, endometrial biopsy if indicated), and provides a personalised treatment plan and cost estimate. Travel dates are confirmed based on the patient's menstrual cycle timing — the optimal window for hysteroscopic polypectomy is the early follicular phase (days 5–10 of the cycle) when the endometrium is thin and visualisation is optimal.

Step 2 — Arrival and Pre-Operative Assessment (Day 1): The patient is received at the airport by a GAF Healthcare coordinator and transferred to the partner hospital or hotel accommodation. On the day of admission, a pre-operative consultation is conducted by the gynaecologist, including repeat speculum examination, review of all diagnostics, anaesthetic assessment (if sedation or GA is planned), informed consent, and nil-by-mouth instructions if applicable.

Step 3 — The Procedure (Day 1 or Day 2, Duration: 10–30 Minutes): For office hysteroscopic polypectomy, the patient is positioned in the lithotomy position and the vaginoscopic technique is used. Distension medium (normal saline, 70–100 mmHg) is instilled, the hysteroscope is advanced to the endocervical canal, the polyp(s) are identified, and excision is performed using Versapoint bipolar electrode or 5 Fr scissors under direct vision. The pedicle base is coagulated to minimise recurrence. The excised specimen is sent immediately to histopathology. Total procedural time is 10–20 minutes for standard cases. For larger polyps requiring resectoscope or morcellator, the patient receives short IV sedation or general anaesthesia (15–30 minutes total operative time).

Step 4 — Immediate Post-Procedure Recovery (Hours 1–4): The patient is monitored in a recovery bay for 1–3 hours post-procedure. Mild cramping and light spotting are expected and managed with NSAIDs (ibuprofen 400 mg or naproxen 500 mg). Vital signs, vaginal bleeding assessment, and pain scoring are documented. The majority of patients are discharged on the same day (day-care basis); an overnight stay is arranged if sedation or GA was used or if the patient requires additional monitoring.

Step 5 — Early Recovery Period (Days 2–7): The patient is advised to avoid sexual intercourse, tampon use, and submersion bathing (swimming, baths) for a minimum of 2 weeks. Light vaginal bleeding or pinkish discharge for 3–7 days is normal. Moderate aerobic activity (walking) is resumed from Day 2; strenuous exercise, heavy lifting, and swimming are restricted for 2 weeks. A follow-up teleconsultation with the treating gynaecologist is scheduled for Day 5–7 to review progress and histopathology results.

Step 6 — Histopathology Review and Discharge Clearance (Day 5–10): Histopathology results are reviewed with the patient. If results are benign (the outcome in >99% of cases), a formal fit-to-fly clearance is issued. If unexpected pathology is identified, the GAF Healthcare team coordinates urgent specialist review and revised management planning before the patient departs.

Step 7 — Return Travel and Remote Follow-Up (Week 2 Onward): International travel is cleared at 7–14 days post-procedure for the majority of patients (no thrombosis risk associated with this minor procedure). A structured remote follow-up protocol — including 4-week and 3-month teleconsultations and repeat Pap smear at 6 months — is provided by GAF Healthcare to ensure long-term monitoring from the patient's home country.