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Trial registered on ANZCTR
Registration number
ACTRN12622000830796
Ethics application status
Approved
Date submitted
9/05/2022
Date registered
14/06/2022
Date last updated
15/05/2023
Date data sharing statement initially provided
14/06/2022
Type of registration
Prospectively registered
Titles & IDs
Public title
Comparing Vaginal Hysterectomy and Manchester Procedure for uterine prolapse
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Scientific title
A prospective cohort study for success of vaginal hysterectomy with vault suspension compared to Manchester-Fothergill Procedure for utero-vaginal prolapse
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Secondary ID [1]
307046
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none
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Universal Trial Number (UTN)
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Trial acronym
The VaMP Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
pelvic organ prolapse
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uterovaginal prolapse
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Condition category
Condition code
Surgery
323495
323495
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0
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Surgical techniques
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
As is usual practice, participants electing to undergo pelvic organ prolapse surgery would be offered uterine preserving surgery such as Manchester procedure (MP) as well as hysterectomy. This is done at a face to face consult with a Urogynaecologist or trainee under the supervision of a Urogynaecologist. After being provided with verbal and written information, patients will choose which procedure they will undergo to address their prolapse. All patients who choose either a MP will be offered enrolment in the study. The Manchester repair will be performed by a Urogynaecologist and/or Urogynaecology subspecialty trainee. The whole procedure would take about 1.5hrs including a cystoscopy at completion.
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Intervention code [1]
323507
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Treatment: Surgery
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Comparator / control treatment
As is usual practice, participants electing to undergo pelvic organ prolapse surgery would be offered uterine preserving surgery such as Manchester procedure (MP) as well as hysterectomy. This is done at a face to face consult with a Urogynaecologist or trainee under the supervision of a Urogynaecologist. After being provided with verbal and written information, patients will choose which procedure they will undergo to address their prolapse. All patients who choose a VH will be offered enrolment in the study. The VH will be performed by a Urogynaecologist and/or Urogynaecology subspecialty trainee and will include a vault suspension procedure. The choice of procedure will be at the discretion of the surgeon. The whole procedure would take about 1.5hrs including a cystoscopy at completion.
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Control group
Active
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Outcomes
Primary outcome [1]
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To assess the recurrence of prolapse after MP versus vaginal hysterectomy (VH) at 6 months, 2 years, 5 years defined as no recurrent prolapse requiring repeat prolapse surgery or pessary assessed by absence of bulge sensation as reported by the patient.
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Assessment method [1]
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Timepoint [1]
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6 months (primary time point), 2 years, 5 years post surgery
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Secondary outcome [1]
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Anatomical outcomes will be defined using the Pelvic Organ Prolapse Quantification System (POPQ)
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Assessment method [1]
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Timepoint [1]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [2]
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Subjective outcome defined as absence of vaginal bulge reported by the patient at 6 months, 2 years, 5 years post surgery.
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Assessment method [2]
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Timepoint [2]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [3]
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Reoperation defined as repeat surgery including for complications or stress urinary incontinence using patient medical records and patient history at follow up appointments.
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Assessment method [3]
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Timepoint [3]
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6 months, 2 years, 5 years post surgery.
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Secondary outcome [4]
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Patient satisfaction determined by Patient Global Impression of Improvement (PGI-I)
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Assessment method [4]
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Timepoint [4]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [5]
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Complications using Clavien-Dindo according to medical record and patient follow up
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Assessment method [5]
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Timepoint [5]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [6]
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Blood loss (mL) using operation report
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Assessment method [6]
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Timepoint [6]
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Immediate post operative period
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Secondary outcome [7]
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Patient reported symptoms using Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6)
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Assessment method [7]
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Timepoint [7]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [8]
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Patient quality of life using the Incontinence Impact Questionnaire, Short Form (IIQ-7)
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Assessment method [8]
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Timepoint [8]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [9]
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Patient quality of life using the Urinary Distress Inventory, Short Form (UDI-6)
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Assessment method [9]
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Timepoint [9]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [10]
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Patient reported symptoms using the Colorectal-Anal Distress Inventory-8 (CRADI-8)
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Assessment method [10]
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Timepoint [10]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [11]
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Patient reported symptoms using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).
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Assessment method [11]
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Timepoint [11]
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6 months, 2 years, 5 years post surgery
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Secondary outcome [12]
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Length of hospital stay according to medical record
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Assessment method [12]
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Timepoint [12]
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Immediate post operative period
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Secondary outcome [13]
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Analgesia requirements according to medical record
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Assessment method [13]
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Timepoint [13]
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Immediate post operative period
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Eligibility
Key inclusion criteria
Inclusion Criteria
All participants between the ages of 18-80 with symptomatic stage I-III pelvic organ prolapse (POP) requesting surgery including hysterectomy, capable of providing informed consent and able to return for follow up.
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Minimum age
18
Years
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Maximum age
80
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion Criteria
Any previous prolapse surgery
Previous surgery in the treatment area in the last year.
Systemic steroids use within the last 3 months
Pelvic organ prolapse (POP) > stage 3 according to pelvic organ prolapse quantification system
Past history of prolapse surgery with transvaginal mesh
Serious systemic disease or any chronic condition that could interfere with study compliance
Uterine pathology that would make uterine preservation inappropriate
Co-morbidities or surgical history that would make a particular approach inappropriate
Any other reason that, in the opinion of the investigator, prevents the subject from participating in the study or compromise the subject safety
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Participants will be allocated to either the Vaginal Hysterectomy or Manchester Procedure groups depending upon their preference for either procedure.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Outcomes were compared with Pearson chi squared test for categorical data and Student t test or Wilcoxon signed rank Test for continuous data as appropriate. 2 sided 95% confidence intervals will be used. Regression analysis will be performed as appropriate.
Pre-treatment & post-treatment changes in patient reported outcomes were analysed using Analaysis of covariance (ANCOVA) to adjust for baseline data.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
1/07/2022
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Actual
5/07/2022
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Date of last participant enrolment
Anticipated
31/05/2025
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Actual
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Date of last data collection
Anticipated
31/05/2030
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Actual
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Sample size
Target
202
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Accrual to date
5
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Mercy Hospital for Women - Heidelberg
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Recruitment hospital [2]
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Monash Medical Centre - Moorabbin campus - East Bentleigh
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Recruitment hospital [3]
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Cabrini Hospital - Malvern - Malvern
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Recruitment postcode(s) [1]
37475
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3084 - Heidelberg
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Recruitment postcode(s) [2]
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3165 - East Bentleigh
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Recruitment postcode(s) [3]
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3144 - Malvern
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Mercy Hospital
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Address [1]
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Mercy Hospital, 163 Studley Rd, Heidelberg VIC 3084
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Country [1]
311357
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Australia
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Primary sponsor type
Hospital
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Name
Mercy Hospital
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Address
163 Studley Rd, Heidelberg VIC 3084
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Country
Australia
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Secondary sponsor category [1]
312754
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Hospital
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Name [1]
312754
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Monash Hospital - Moorabin
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Address [1]
312754
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Centre Rd, Bentleigh East, VIC 3165
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Country [1]
312754
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
310850
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Mercy Hospital
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Ethics committee address [1]
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163 Studley Road Heidelberg VIC 3084
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Ethics committee country [1]
310850
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Australia
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Date submitted for ethics approval [1]
310850
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Approval date [1]
310850
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22/04/2022
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Ethics approval number [1]
310850
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2022-005
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Summary
Brief summary
The Manchester Procedure (MP) and vaginal hysterectomy with vault suspension (VH) are two surgical options for the treatment of pelvic organ prolapse (POP). The evidence of benefit is currently limited to one prospective trial and several retrospective reviews. The two procedures have been studied in isolation though much more data exists for VH. Recent Danish registry data in a matched cohort study (n=590) suggested prolapse outcomes after Manchester repair were better than those after vaginal hysterectomy with vault suspension. In addition to the question of effectiveness of the procedure, the economic benefits of MP versus VH have been studied in the international literature. Costs for the first 20 months after the operation were higher in the VH group when analyzing the primary operation only, and higher still when including subsequent activities within 20 months. Given the MP is performed far less frequently in Australia, presumably due to patient selection and surgeon preference, there is a benefit for the local and international community to learn more about the differences in outcome between the procedures. Local data that shows equivalent outcomes may encourage increased uptake of the procedure which may lead to health gains for the patient and improved economic outcomes for hospitals.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Lore Schierlitz
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Address
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Mercy Hospital
163 Studley Rd, Heidelberg VIC 3084
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Country
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Australia
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Phone
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+61 408118323
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Victoria Buckley
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Address
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Monash Hospital
823-865 Centre Rd. Bentleigh East VIC 3165
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Country
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Australia
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Phone
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+61 404161466
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Lore Schierlitz
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Address
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Mercy Hospital
163 Studley Rd, Heidelberg VIC 3084
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Country
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Australia
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Phone
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+61 408118323
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Fax
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Email
119088
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
The researchers who contribute their study data will review but not widely available
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
15929
Study protocol
384007-(Uploaded-04-05-2022-10-42-19)-Study-related document.docx
15930
Ethical approval
384007-(Uploaded-09-05-2022-10-24-12)-Study-related document.pdf
15931
Informed consent form
384007-(Uploaded-04-05-2022-10-42-32)-Study-related document.docx
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF