Cervical Polypectomy
Cervical polyps are usually benign but should always be removed and sent to pathology for microscopic examination. Polyps range greatly in size from small to large (Fig. 47–1). Large polyps may spill into the vagina (Fig. 47–2). In either circumstance, the presence of a polyp is commonly associated with contact bleeding and increased vaginal discharge. For small polyps, a Kelly clamp is placed across the pedicle and is twisted clockwise or counterclockwise until the polyp separates (Fig. 47–3). A swab soaked with Monsel’s solution is placed onto the residual base pedicle for hemostasis.
Large polyps with thick, vascular pedicles must be clamped and suture-ligated or simply ligated then cut off (Fig. 47–4). If the base of the pedicle cannot be easily exposed, then the posterior wall of the cervix should be split to allow visualization. This is done by injecting 10 to 15 mL of 1 : 100 vasopressin into the posterior cervical lip. Then, by utilizing a carbon dioxide (CO2) laser or a needle electrode, the cervix is cut vertically in the midline to a point 1 cm below the internal os (Fig. 47–5A, B). The cervix is closed with 3-0 Vicryl interrupted sutures (Figs. 47–6A through D and 47–7).
