A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. Minimally Invasive Surgical Techniques--Laser, EndoThermal or Endorescetion.
OBJECTIVE
To study the frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators.


METHODS
Prospective survey with additional retrospective reporting by theatre staff.


METHODS
300 National Health Service and independent hospitals in the United Kingdom (excluding Scotland).


METHODS
10,686 women registered by 690 doctors (1-222 cases/doctor) from April 1993 to October 1994.


METHODS
Mailings were sent to relevant medical and non medical staff at every hospital to ascertain who performed the operations. These doctors were asked to complete a questionnaire detailing their previous experience. Completed patient registration forms were returned each month. Theatre contacts returned lists of cases reported in theatre registers.


METHODS
Perioperative, post-operative and delayed complications by method of surgery and experience of operator.


RESULTS
Two directly related deaths were reported. Laser and rollerball ablations were associated with least operative and post-operative complications. Combined loop and rollerball diathermy was associated with a higher rate, but with fewer immediate operative complications than loop resection alone. Endometrial thinning agents were not associated with decreased complications. Fibroids were associated with increased operative haemorrhage. Early post-operative complication rates ranged from 0.77% to 1.51%. Six-week follow up in 82.5% of the women revealed few complications (1.25% to 4.58%). Increasing operative experience was associated with fewer uterine perforations in the loop resection alone group (chi 2 for trend, P < 0.001), but had no effect on operative haemorrhage in any group.


CONCLUSIONS
These procedures were used widely in 1993 to 1994 with low morbidity and mortality. The techniques may be relatively easily learned in the apprenticeship system without compromising safety. Combined diathermy resection appears safer than loop resection alone, but laser and rollerball ablation were safest.
Overton
C
C
Clinical Audit Unit, Royal College of Obstetricians and Gynaecologists, St Mary's Hospital for Women and Children, Manchester, UK.
Hargreaves
J
J
Maresh
M
M
D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects; D002983:Clinical Competence; D003452:Cryosurgery / Q000009:adverse effects*; D004564:Electrocoagulation / Q000009:adverse effects*; D004717:Endometrium; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D017075:Laser Coagulation / Q000009:adverse effects*; D008599:Menstruation Disturbances / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies