Key Conditions for Successful Implementation of the Manchester Procedure as Primary Surgical Treatment for Mild to...

Recent evidence supports the clinical and economic advantages of the Manchester procedure (MP) over sacrospinous hysteropexy (SSH) in women treated for mild to moderate uterine prolapse. However, its use remains inconsistent, resulting in a notable variation in current practice. This study explores gynecologists' barriers and facilitators to adoption of the MP, aiming to guide the development of a targeted implementation strategy.

From March to June 2025, we conducted semi-structured interviews with gynecologists (n = 12) from the Netherlands in different stages of implementation to identify barriers and facilitators. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis, ensuring a structured assessment of key domains.

A total of 12 barriers and 20 facilitators were identified in 13 constructs across all CFIR domains. Key facilitators for implementation included strong regional collaboration networks, the low complexity of the surgical technique, peer-driven motivation to align with national trends, and overall trust in the evidence, although the latter varied between clinicians. Main barriers were the personal and organizational effort required for training and implementation, particularly in the absence of an experienced colleague, satisfaction with SSH results, and concerns about lower reimbursement for the MP.

This study identified key barriers and facilitators influencing the adoption of the MP from the perspective of gynecologists, emphasizing the clinical, organizational, and financial factors involved. Addressing these barriers and leveraging facilitators could enhance adoption of the MP, potentially improving treatment outcomes and reducing healthcare costs.