Hysterectomy with less pain

Martine Malepart suffered from severe vaginal bleeding for almost a year and a half. “I had to constantly bring a change of linen. I was on the bus and I was always afraid of getting stained,” says the 47-year-old woman.

She also had severe abdominal pain. Her symptoms were caused by an 8 cm cyst on her uterus and a thin uterus. He tried drugs a few times with no success.

When d^R Mihnia Kangal, a gynecologist at Notre-Dame Hospital, offered to remove her entire uterus without incisions in the abdomen, and she did not hesitate for a second. “I was very happy to know that I didn’t have to go through that anymore. »

Martin Malepart was one of the first patients in Quebec to have her uterus removed using a technique called vNotes. The intervention took place last November.

“When I woke up, I was sure I hadn’t been operated on. I felt better. I thought the doctor would say no operation,” she recalled. She was released from the hospital the same day and her bleeding quickly stopped.

Less pain and complications

According to statistics from the Régie de l’assurance santé du Québec (RAMQ), by 2023, 7,244 women will have had their hysterectomies. “There are some diseases that cannot be treated better than hysterectomy, which may be fibroids or bleeding that cannot be controlled by medication,” says Dr.^R Kangal.

Removal of the uterus through the vagina without abdominal incisions, or vaginal hysterectomy, is the recommended approach if possible.

However, this technique is only possible in the event of “prolapse”, i.e. when the pelvic organs descend towards the entrance to the vagina.

When the uterus does not descend or it is too large, obstetricians may choose laparoscopic intervention, which allows the use of a camera to observe the inside of the body through small openings in the abdominal wall and remove the uterus.

The new vNotes technique combines the advantages of vaginal and laparoscopic operations. This approach does not require abdominal incisions, as the procedure is performed entirely through the vagina using a camera and device that provides access to the uterus and ovaries.

Studies show that female patients experience less pain, less frequent complications, and shorter hospital stays.

A hundred operations

Obstetrician Mihnea Gangal first discovered this approach at an international conference in 2021. It has already been implemented in several countries, including China, Belgium and the United States.

Only certain complex cases, particularly those associated with cancers or endometriosis, are ineligible.

After training in America, D^R Gangal performed his first surgery during the pandemic. Now he has earned more than hundred. “I have a lot of requests from patients for this surgery,” he says. He can’t accept everyone, his waiting period is already a year and a half.

Notre-Dame Hospital was one of the first hospitals in Canada to consistently use this approach.

Practice dozens of times

On the second floor of Notre-Dame Hospital, colorful anatomical models designed by Drs.^R Gangal is placed on a long work table. It is with this tool that the specialist teaches the new approach to obstetricians from various hospitals in Quebec.

Each model corresponds to a phase of the intervention. “You need to do about 30 to 40 repetitions of the same gesture to become proficient,” says Dr.^R Kangal. The workshop will last for half a day.

Once obstetricians are trained in simulation models, she accompanies them during their first surgery. “Most of my colleagues think it’s easy, but there’s some learning involved and it’s relatively difficult. » If necessary, he can complete the surgery himself. Before you’re comfortable with the technique, you need to operate on 10 to 15 patients, he notes.

In recent months, he has traveled as a guide to Quebec, Gatineau and Sorrel. His wish: The technique should spread throughout the province.