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    Variation in Surgical Technique (VaST): How and why do surgical techniques to perform native tissue pelvic organ prolapse repairs vary between UK based surgeons and does this affect the outcome of surgery?

    Fairclough, Emily Sara

    [Thesis]. Manchester, UK: The University of Manchester; 2017.

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    Abstract

    Overall AbstractIntroductionSurgical techniques used to perform native tissue pelvic organ prolapse (POP) repair vary between surgeons in the UK and other countries. There is a lack of evidence exploring whether this variation in practice influences the outcomes of surgery.ObjectiveTo evaluate how and why a cohort of UK surgeons use particular surgical techniques when performing native tissue POP surgery and whether this influences the outcome of surgery.MethodA mixed methods study. A questionnaire survey was conducted to detail current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).This informed qualitative research (video observations of surgery, audio taped interviews with surgeons and fieldwork) to categorise how surgeons operate and why surgeons use certain surgical techniques when performing native tissue POP surgery. The influence of different aspects of the surgical technique on patient outcomes following native tissue anterior repair in women recruited to the PROSPECT trial were then investigated using the themes from the qualitative part of the study.ResultsSurgical techniques used to perform POP surgery vary between surgeons who recruited to the PROSPECT and VaST studies. The techniques used varied between surgeons in each step of the procedure and themes were derived from these steps rather than the procedure in its entirety. Categorisation of themes was challenging due to the subjective elements of surgery and the lack of standard terminology to describe techniques. Four themes were identified to explain why variation in surgical practice exists; The surgical journey; Rationalising practice; Contextual factors; And, Concepts of success. Although surgeons expressed a willingness to incorporate evidence based medicine into practice there was a reported lack of evidence on which to base practice. Certain aspects of technique (depth of dissection, method of repair, fascia suture material and skin suture method) were observed to influence the subjective and anatomical outcomes of surgery.ConclusionNative tissue anterior repair surgery has been categorised and the reasons for practice variation identified. Aspects of surgical technique were found to influence the outcomes of POP surgery. Standardisation of surgical terminology is required. These results should raise awareness of the influence of surgical technique on outcomes and should inform future RCT in this area to identify if a change in practice is required.

    Layman's Abstract

    Prolapse is a common condition in women and the symptom that women commonly describe is “the feeling of a lump or bulge at the entrance of or coming out of the vagina”. There are 3 compartments or walls of the vagina including the front (anterior), back (posterior) and top (vault or cervix). Prolapse can occur in any of these compartments.One of the treatments for prolapse is surgery. There are concerns about the success rate of the surgical repair of prolapse especially the front wall. There have been some studies that show the surgical techniques used to repair prolapse of the front and back walls vary between different surgeons but the findings have been limited by the quality of data and lack of clear definitions. This study looks in more detail at how the surgical techniques to repair the front and back walls of the vagina vary as well as the reasons behind these variations in surgical technique. It is not clear currently whether this surgical technique variation affects the outcome of surgery and the results of this study will be used to assist in answering this question.

    Bibliographic metadata

    Type of resource:
    Content type:
    Administered thesis
    Form of thesis:
    Alternative Format
    Type of submission:
    Doctoral level ETD - final
    Thesis title:
    Variation in Surgical Technique (VaST): How and why do surgical techniques to perform native tissue pelvic organ prolapse repairs vary between UK based surgeons and does this affect the outcome of surgery?
    Degree type:
    Master of Philosophy
    Degree programme:
    MPhil Medicine PT (DBM)
    Publication date:
    2017-05-30T17:02:42
    Institution:
    The University of Manchester
    Location:
    Manchester, UK
    Total pages:
    237
    Abstract:
    Overall AbstractIntroductionSurgical techniques used to perform native tissue pelvic organ prolapse (POP) repair vary between surgeons in the UK and other countries. There is a lack of evidence exploring whether this variation in practice influences the outcomes of surgery.ObjectiveTo evaluate how and why a cohort of UK surgeons use particular surgical techniques when performing native tissue POP surgery and whether this influences the outcome of surgery.MethodA mixed methods study. A questionnaire survey was conducted to detail current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).This informed qualitative research (video observations of surgery, audio taped interviews with surgeons and fieldwork) to categorise how surgeons operate and why surgeons use certain surgical techniques when performing native tissue POP surgery. The influence of different aspects of the surgical technique on patient outcomes following native tissue anterior repair in women recruited to the PROSPECT trial were then investigated using the themes from the qualitative part of the study.ResultsSurgical techniques used to perform POP surgery vary between surgeons who recruited to the PROSPECT and VaST studies. The techniques used varied between surgeons in each step of the procedure and themes were derived from these steps rather than the procedure in its entirety. Categorisation of themes was challenging due to the subjective elements of surgery and the lack of standard terminology to describe techniques. Four themes were identified to explain why variation in surgical practice exists; The surgical journey; Rationalising practice; Contextual factors; And, Concepts of success. Although surgeons expressed a willingness to incorporate evidence based medicine into practice there was a reported lack of evidence on which to base practice. Certain aspects of technique (depth of dissection, method of repair, fascia suture material and skin suture method) were observed to influence the subjective and anatomical outcomes of surgery.ConclusionNative tissue anterior repair surgery has been categorised and the reasons for practice variation identified. Aspects of surgical technique were found to influence the outcomes of POP surgery. Standardisation of surgical terminology is required. These results should raise awareness of the influence of surgical technique on outcomes and should inform future RCT in this area to identify if a change in practice is required.
    Layman's abstract:
    Prolapse is a common condition in women and the symptom that women commonly describe is “the feeling of a lump or bulge at the entrance of or coming out of the vagina”. There are 3 compartments or walls of the vagina including the front (anterior), back (posterior) and top (vault or cervix). Prolapse can occur in any of these compartments.One of the treatments for prolapse is surgery. There are concerns about the success rate of the surgical repair of prolapse especially the front wall. There have been some studies that show the surgical techniques used to repair prolapse of the front and back walls vary between different surgeons but the findings have been limited by the quality of data and lack of clear definitions. This study looks in more detail at how the surgical techniques to repair the front and back walls of the vagina vary as well as the reasons behind these variations in surgical technique. It is not clear currently whether this surgical technique variation affects the outcome of surgery and the results of this study will be used to assist in answering this question.
    Keyword(s):
    Thesis main supervisor(s):
    Thesis co-supervisor(s):
    Degree grantor:
    Language:
    en

    Institutional metadata

    University researcher(s):
    Academic department(s):

    Record metadata

    Manchester eScholar ID:
    uk-ac-man-scw:309343
    Created by:
    Fairclough, Emily
    Created:
    30th May, 2017, 16:02:42
    Last modified by:
    Fairclough, Emily
    Last modified:
    8th June, 2018, 12:05:43

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