Endometrial resection--a comparison of techniques

To assess the long-term effectiveness and safety of endometrial resection, an ongoing prospective study of 927 patients, followed for 1 to 5 years, was carried out. The patients met criteria previously adopted for vaginal hysterectomy. Three techniques were used, modified over time with experience gained and failures encountered: Technique 1: Resection alone; Technique 2: Resection, followed by roller-ball cautery of the whole endometrium; Technique 3: Laparoscopic control, resection, roller-ball cautery, further resection especially in the cornua and fundus and finally laparoscopic cautery of the cornual region of the uterus. Various parameters were measured including preparation of the endometrium, pathology present, complications and outcomes. There was a marked improvement in the success of the procedure with changes from Technique 1 to 2 to 3. There was a fall in the failure rate from 22% to 5%. These results were statistically highly significant (p < 0.0001). The best results obtained were in women with endometrial polyps and pure dysfunctional bleeding with good results in cases of intramural fibroids and adenomyosis. There were no deaths and no cases of long-term adverse sequelae resulting from complications, but the following were encountered: perforation of the uterus, hyponatraemia, pregnancy, infection, unanticipated malignancy and cervical stenosis. It is concluded that in view of the high success rate and relative lack of serious complications, endometrial ablation should be considered the treatment of choice in cases of dysfunctional bleeding in women who have completed their families.