What is endometrial ablation?

Authors:

Overton C. Hargreaves J. Maresh M.

Institution:

Dr. M. Maresh, The Clinical Audit Unit, Royal Coll.

Obstetricians Gynaecol., St Mary's Hosp. Women and Children,

Hathersage Road, Manchester M13 0JH; United Kingdom.

Title:

A national survey of the complications of endometrial destruction for menstrual disorders: The MISTLETOE study (1998-2077).

Source:

Contemporary Reviews in Obstetrics and Gynaecology. Vol 10(3) (pp09-216), 1998.

Abstract:

The MISTLETOE study was designed to investigate the Frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators. It was a prospective survey with additional retrospective reporting by theatre staff in 300 NHS and independent hospitals in the UK (excluding Scotland). 10,686 women were registered by 690 doctors (1-222 cases/doctor) between April 1993 and October 1994. Two directly related deaths were reported. Laser and rollerball ablations were associated with least operative and postoperative 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 postoperative 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 (chi2 for trend p< 0.001), but had no effect on operative haemorrhage in any group. These procedures were used widely in 1993-4 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.

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