Survey of use of local infiltration and vasoconstrictors in vaginal surgery

Latthe, Pallavi; Kadian, Suman; Parsons, Matthew; Toozs‐Hobson, Philip

doi:10.1007/s10397-007-0289-2

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…In older descriptions of native tissue POP repair, no infiltration was used [ 11 , 13 ]. Infiltration type was not recorded in this study; however, in other studies it has been recorded and the most commonly used infiltrate varied between local anaesthetic [ 5 ] and normal saline [ 7 , 14 ]. Surgeons’ rationale for using local infiltration has been assessed [ 14 ], but the reason behind the choice of infiltrate was not evaluated.…”

Section: Discussionmentioning

confidence: 92%

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

et al. 2017

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Introduction and hypothesisEvidence-based medicine should result in better standardisation of practice. This study aims to evaluate whether there remains variation in surgical techniques in native tissue and graft/mesh repairs of pelvic organ prolapse (POP) in UK practice.MethodsA questionnaire survey was conducted to describe 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).ResultsThe questionnaire return rate was 90% (n = 56 out of 62). Substantial variations in surgical techniques were seen at every step of the procedure. Native tissue repair: most surgeons used infiltration, 95% (n = 53 out of 56), but the volume used varied (10–80 ml). All but one surgeon performed a midline incision; this surgeon performed an elliptical incision. The depth of tissue dissection varied, being both above and below the vaginal muscularis (fascia). Fascial repair methods included midline, closure of separate fascial defects, paravaginal repair and rectal/levator plication. Graft/mesh repairs: many different products and manufacturers were used. There was variation in the method of attachment of graft/mesh inserts and their placement in relation to the fascia. For both native tissue and graft/mesh repairs, the method of fascial dissection, suturing methods and suture material varied. Most surgeons inserted a pack, 91% (n = 50 out of 55), soaked in varying substances before use.ConclusionsThere is considerable variation between UK-based surgeons in the surgical techniques used to perform both native tissue and graft/mesh-augmented POP repairs. Further research is required to determine whether these differences influence outcome.

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Section: Discussionmentioning

confidence: 92%

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

et al. 2017

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“…To our knowledge, this is the first study to relate the techniques in every step of an anterior POP repair procedure with outcome. Previous studies have looked at the effect of single aspects of technique [16][17][18][19][20]. One previous randomised control trial of native tissue fascial repair techniques compared two techniques, "standard colporrhaphy" and "ultra-lateral colporrhaphy".…”

Section: Discussionmentioning

confidence: 99%

Does variation of surgical technique affect native tissue anterior pelvic organ prolapse repair outcomes?

et al. 2023

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Introduction and hypothesis The Variation in Surgical Technique study (VaST), demonstrated the large variation in surgical techniques used in native tissue (NT) anterior pelvic organ prolapse (POP) repairs. However, there are few comparative studies of different surgical techniques. This study was aimed at exploring whether surgical technique influenced the outcomes of NT anterior POP repairs. Methods The surgical techniques of 22 consultant surgeons performing NT anterior POP repairs were filmed and categorised. These surgeons performed 809 anterior repairs within the PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial (PROSPECT). Logistical regression models were used to determine the influence of the different surgical techniques on subjective and objective outcomes, using data collected during PROSPECT. Results In adjusted multivariate linear regression models, fascial-flap repair was associated with an improved subjective outcome (POP-SS) compared with midline plication (β = −2.50 [−4.42 to −0.57]; p = 0.01). At 12 months, separate fascial defect repair was associated with a poorer objective outcome than midline plication (OR 6.06 [1.82–3.52], p = 0.006). At 24 months, deep dissection was associated with a poorer POP-SS than superficial dissection (0.32–2.60, p = 0.0). Continuous-locking closure of the skin was also associated with improved POP-SS compared with continuous non-locking closure (12 months: β = −1.94 [−3.42 to −0.45], p = 0.01). Conclusion Surgical technique may influence the outcome of native tissue anterior POP repairs. Our results should not change practice but inform future research; to develop methods of explicitly recording surgical techniques and allow confirmation of the effect of these aspects of technique on outcome.

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“…In a survey conducted in UK 86 percent of Gynecologists uses infiltration before vaginal hysterectomy. 4 Some evidence suggests that use of infiltration do not prevent visceral injuries during vaginal surgerie. 5 Though it appears that hydro dissection facilitates tissue dissection, there is some evidence that hydro dissection to do not facilitate tissue dissection.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of outcome following paracervical infiltration with or without saline and adrenaline during vaginal hysterectomy

Nambiar

Yettinamani

Pai

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Paracervical infiltration is used in vaginal hysterectomy to facilitate dissection. Use of paracervical infiltration however can be associated with local ischemia and infection. We did a study to find out its benefits during vaginal hysterectomy.Methods: It was a prospective case control study. Patients were divided into two groups. In the first group, no paracervical infiltration was given. In the second group paracervical infiltration was given before hysterectomy. The operating time, blood loss and postoperative infection were noted in each group.Results: The operating time was slightly higher in vaginal hysterectomy group without infiltration (p=0.025) The operating time in laparoscopic assisted vaginal hysterectomy group was not significant (p=0.0296). There was significant difference in Hemoglobin after surgery in both groups (p value 0.614 for vaginal hysterectomy and 0.173 for laparoscopic assisted vaginal hysterectomy). There was no case of infection in both groups.Conclusions: From our study, we concluded that paracervical infiltration offers no distinctive advantage during vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy.

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Survey of use of local infiltration and vasoconstrictors in vaginal surgery

Cited by 8 publications

References 11 publications

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

Does variation of surgical technique affect native tissue anterior pelvic organ prolapse repair outcomes?

Evaluation of outcome following paracervical infiltration with or without saline and adrenaline during vaginal hysterectomy

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