Hysteroscopic fractionation may be a better way to remove endometrial polyps than traditional electrosurgical excision, according to a new randomized controlled trial (RCT) published online March 6 on the website of the Journal of Obstetrics & Gynecology. ”This study provides strong evidence that hysteroscopic fractionation performs faster and more successful polyp removal with less patient pain. More and more women patients are preferring hysteroscopic fractionation to remove endometrial polyps than traditional electrosurgical excision.” Paul from Birmingham Women’s Hospital, Birmingham and Sheffield University Hospitals, UK? Smith and his colleagues write. The fractionation technique is a polyp tissue removal procedure and has been used for laparoscopic or robotic-assisted hysterectomy, myomectomy and hysterectomy for fibroids. The study was a single-blind randomized controlled trial study of 121 women recruited from 2 large urban teaching hospitals in Birmingham or Sheffield. Between July 2012 and May 2013, these women were randomly assigned in a 1:1 ratio to the community hysteroscopic fractionated endometrial polypectomy combined with electrosurgical excision group. Women with hysteroscopic diagnosis of expected malignant polyps were excluded. Self-reported data collected immediately after the procedure included acceptability (4-point scale) and pain (100-mm visual analog score). Polypectomy was performed by 3 experienced surgeons, although they had more experience in conventional electrosurgery. Technical aspects were recorded by the surgeon after the operation. The median time to completion of fractionation was 5 minutes and 28 seconds compared to 10 minutes and 12 seconds for electrosurgery (p<0.001). Complete polypectomy was completed in 61 of 62 patients (98%) in the fractionation group compared with 49 of 59 patients (83%) who underwent electrosurgery (ratio 12.5; 95% CI, 1.5-100.6, P=0.02). Compared with the mean electrodesiccation pain score of 52.0, the fractionation score was 35.9, a full 16.1 points lower (95% CI, -24.7 to -7.6; P<0.001). The majority (99%) of women considered fractionated polypectomy to be "acceptable. Complications included a vasovagal reaction in 1 of 62 (2%) women who underwent fractionation and 6 of 59 (10%) who underwent electrosurgery, and 1 serious adverse event (endometritis) that occurred after fractionation, after which the patient was treated with antimicrobial medication. The limitation was the presence of an uncertain distribution of potentially complex factors, with more endometrial polyps in those women treated with fractionation than in the group undergoing electrosurgery. More women in the fragmentation group were from Sheffield than Birmingham. The authors cite several advantages of hysteroscopic fractionation for endometrial polyps over electrodesiccation, including less manipulation with instruments, better visualization, less foam formation, the ability to perform both cutting and extraction, reduced patient discomfort, and cost of visits. However, it is also addressed in this study that segmented tissue may not provide good specimens for histologic analysis and thus not diagnose all specimens.