A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study

Objectives: To study the frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators. Design: Prospective survey with additional retrospective reporting by theatre staff. Setting: 300 National Health Service and independent hospitals in the United Kingdom (excluding Scotland). Population: 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. Main outcome measures 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.