In partnership with Royal United Hospitals Bath NHS Foundation Trust, we have published a new real-world evaluation examining the implementation of an innovative device designed to optimise the repair procedure for women and birthing people after childbirth.
The evaluation focused on the Hegenberger Retractor, a unique, flexible tool designed to provide steady retraction and support tissue exposure during the suturing of severe 2nd, 3rd and 4th-degree perineal and vaginal tears.
Perineal trauma is a significant concern in maternity care, with up to 90% of first-time mothers experiencing some degree of injury during vaginal birth. Of these, third- and fourth-degree tears, known as Obstetric Anal Sphincter Injuries (OASI), affect approximately 19,000 people annually in England.
If these injuries are not accurately diagnosed and repaired, they can lead to long-term physical and emotional complications, including chronic pain and incontinence. Current repair practices often rely on manual retraction, which can be hampered by poor visualisation and the limited availability of surgical assistants.
Zoey Robinson, Consultant Obstetrician at Royal United Hospitals Bath NHS Foundation Trust, said:
“We must look at any innovation that may have the potential to aid the repair of an anal sphincter injury as a consequence of childbirth. If we identify any improvement that can be made in the healing and function after this injury, however small, we have made a big step forward in the postnatal outcomes for women.”
The real-world evaluation
Using a mixed-methods, quality improvement approach, the evaluation monitored the use of the retractor across 70 possible OASI repairs at RUH Bath between February and September 2025. The study gathered quantitative clinical data alongside qualitative feedback from staff surveys and interviews to assess surgical efficiency and clinician experience.
Key findings
The evaluation demonstrated a moderate level of real-world adoption, with the retractor used in 47% of relevant repairs. Clinicians reported significant procedural benefits, including:
- Improved visualisation: 79% of clinicians agreed the device provided a clearer view of the trauma.
- Better ergonomics: the device allowed clinicians to work hands-free, improving the ability to use best surgical practices.
- Reduced reliance on assistants: 55% of clinicians agreed the retractor reduced the need for a surgical assistant during suturing.
Crucially, the evaluation found no signal of harm to women and birthing people. While statistical analysis noted longer surgical times (likely reflecting the learning curve and selective use in more complex cases), staff often perceived the tool as a time-saver.
Malene Hegenberger, creator of the Hegenberger Retractor, said:
“I am delighted to see the positive outcomes of this evaluation, particularly given the complexity of the repairs, the challenges faced during the evaluation, the steep learning curve, and the limited experience with the Hegenberger Retractor.”
Staff insights and recommendations
The evaluation identified several enablers for adoption, including the simplicity of the device design and dedicated initial training. However, it also highlighted barriers such as the device not being routinely included in operative packs and challenges with positioning in patients with a higher BMI.
The findings offer a valuable roadmap for wider adoption, emphasising the need for specialised hands-on training and better integration into routine theatre workflows.
Hayley McBain, Senior Evaluation Manager at Health Innovation West of England, said:
“This evaluation provides valuable real-world evidence on the implementation of the Hegenberger Retractor in NHS maternity care, highlighting both its potential benefits and the practical considerations for adoption. We encourage NHS organisations, clinicians and innovators to use these findings to inform future research, implementation and evidence-based decision-making.
“We are proud to shine a spotlight on such an important area of women’s health and on an innovative device that has the potential to optimise a procedure with lifelong implications for patients if not performed correctly.”
Health Innovation West of England will continue to support both the manufacturer and the UK distributor of the Hegenberger Retractor as they explore the next steps towards wider adoption and work with local clinical systems to support adoption readiness and align clinical demand with the company’s innovation.
Find out more
Read the full evaluation report.
Read our case study on the project.
For more information, please email our Evaluation and Insights Team at healthinnowest.evaluation@nhs.net.
Posted on August 5, 2026
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