Clampless Cervical Polypectomy

Every now and then we get a patient with a leiomyomatous polyp growing down from one of the lips of the uterine cervix, sometimes big enough to come out of the vulva. A natural tendency of many residents is to put a clamp across its pedicle, cut it off and then replace the clamp with a transfixion suture of delayed absorbable suture material. The pedicle is often thick, and putting a clamp on it is not a very good idea because there are high chances of the clamp cutting through or the ligature slipping. We prefer to perform clampless polypectomy in such cases. We make an incision in the mucosa covering the pedicle of the polyp, about 5-10 mm from its origin. Then we cut through the pseudocapsule of the leiomyoma, and dissect between the leiomyoma and the pseudocapsule. If it is not possible to dissect at the base, we divide the pseudocapsule through the length of the leiomyoma, and then dissect the leiomyoma out of the two halves of the pseudocapsule. Then we excise the redundant part of the mucosa and the pseudocapsule. Hemostasis is achieved by electrocauterization. Finally we approximate the edges of the mucosa with interrupted sutures of No. 1-0 delayed absorbable suture. The advantages of this technique over the clamp technique are: 1.No part of the pedicle is left behind. 2.The reconstructed cervix looks much more normal. 3.Complications like the clamp cutting through the fleshy pedicle and the ligature slipping over the smooth mucosa are avoided. We have done a large number of cases using this technique, and have quite satisfying results.