A method to improve the accuracy between the presumed depth of excision and the actual depth of excision in women (2018)

Type of publication:
Journal article

Author(s):
*Papoutsis D.; *Kandanearachchi P.; *Sahu B.; Antonakou A.; Tzavara C.

Citation:
Hippokratia; 2018; vol. 22 (no. 3); p. 113-121

Abstract:
Background: We aimed to determine whether continuous auditing of the presumed depth of excision and
comparing with the actual depth of excision in women having large loop excision of the transformation zone (LLETZ) improves the ability to acquire the desired depth of excision.
Method(s): This was a prospective study of women submitted to a single LLETZ treatment between 2017-2018. Two senior colposcopists recorded what they presumed was the depth of excision at the time of treatment and the subsequent histopathology report provided the actual excised depth. Multiple linear regression identified independently associated parameters with the difference between presumed and actual excision depth. Nonlinear regression determined the learning plateau defined as the theoretical minimal score of difference one could achieve with infinite practice.
Result(s): There were significant differences in practices with the first colposcopist using an 18-mm loop and the second colposcopist a 15-mm loop in the majority of cases. The median absolute and percentage difference between the presumed and actual excised depth was 2 mm and 16.6% and 3.5 mm and 35.4% for the two colposcopists, respectively. A learning plateau was identified only for the first colposcopist. We found that auditing consecutive excisions decreased significantly the difference between the presumed and actual depth of excision with a learning plateau at 2.2 mm of absolute difference and 22.6% of percentage difference and with a learning rate of 13 cervical excisions.
Conclusion(s): There might be a benefit in auditing our treatment practice as there seems to be a learning
plateau through this method

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Auditing the complications of LLETZ cervical treatment versus cold-coagulation over a one-year period (2017)

Type of publication:
Conference abstract

Author(s):
*Ali N.; *Kandareachichi P.; *Blackmore J.; *Papoutsis D.; *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; Nov 2017; vol. 124 ; p. 33

Abstract:
Introduction We aim to audit the complication rates of women treated with either LLETZ cervical treatment or cold-coagulation in our colposcopy unit against the standards set out by the NHSCSP guidelines. It is reported that the proportion of treatment associated with primary haemorrhage that requires a haemostatic technique must be less than 5%, and the proportion of cases admitted as inpatients because of treatment complications must be less than 2%. Methods We retrospectively collected data from our electronic colposcopy database for women treated over the time period of August 2015 – July 2016. Hospital notes were retrieved for those who were identified with complications for further data collection. Results We identified 494 patients with LLETZ and 24 patients with cold-coagulation treatment. There were no complications noted after cold-coagulation. There were 12/494 (2.4%) patients who had post-LLETZ bleeding with one patient being admitted as an inpatient for further management (1/518 or 0.2). The bleeding occurred between 2-28 days after treatment, with 42% of women having had treatment under a general anaesthetic mainly due to a large lesion size. The mean age of women with bleeding was 39 years (range: 27-59) with a mean BMI of 26 kg/m2 (range: 17-34). Only one in three women with bleeding required oral antibiotics, and less than 8% of women had a temporary vaginal pack. All women with bleeding were self-referred directly to the colposcopy service without prior GP consultation/examination. Conclusion We are compliant with the NHS-CSP auditable standards with regards to post-treatment complications and inpatient admissions. As very few women actually necessitated further management this puts into question the appropriateness of the initial referral of these women. Areas for improvement therefore involve educating both staff and patients about the possibility of bleeding after excisional treatment and the role of the GP in reviewing these women before onward referral to the colposcopy service.