Every year in Quebec, more than 7,000 women have their uterus removed due to cancer, fibroids or abnormal bleeding. This type of operation can require a long recovery, but a new approach that causes less pain and complications is spreading in the province, thanks to a doctor at Notre-Dame Hospital in Montreal.
What there is to know
A new technique, called vNotes, combines the advantages of different existing approaches to uterine surgery.
This approach results in less pain, fewer complications and shorter hospital stays, studies show.
Notre-Dame Hospital is one of the first hospitals in Canada to use it regularly.
Martine Malepart suffered from heavy vaginal bleeding for almost a year and a half. “I had to bring a change of clothes all the time. I was on the bus and I was always afraid of getting stained,” says the 47-year-old.
She also had severe abdominal pain. Her symptoms were caused by an 8 cm cyst on her ovary and a thinned uterus. She tried medication a few times, without success.
When the Dr Mihnea Gangal, a gynecologist at Notre Dame Hospital, offered to have her uterus completely removed without abdominal incisions, and she didn’t hesitate for a second. “I was so happy to know that I wouldn’t have to go through this anymore.”
Martine Malepart is one of the first patients in Quebec to have her uterus removed using the technique called vNotes. The procedure took place last November.
“When I woke up, I was sure I hadn’t had surgery. I felt fine. I thought the doctor was going to tell me the surgery hadn’t happened,” she recalls. She was discharged from the hospital that same day, and her bleeding quickly stopped.
Less pain and complications
In 2023, 7,244 women had their uterus removed, according to figures from the Régie de l’assurance maladie du Québec (RAMQ). “There are certain diseases that cannot be treated better than by removing the uterus, these could be fibroids or bleeding that cannot be controlled with medication,” explains Dr.r Gangal.
Removal of the uterus through the vagina without abdominal incisions, or vaginal hysterectomy, is the recommended approach when feasible.
However, this technique is only possible in cases of “prolapse”, i.e. when the pelvic organs descend towards the entrance of the vagina.
When the uterus has not descended or is too large, gynecologists may opt for laparoscopic surgery, which allows the inside of the body to be observed using a camera through small openings in the abdominal wall and the uterus to be removed.
PHOTO MARCO CAMPANOZZI, THE PRESS
According to the Dr Gangal, you have to operate on between 10 and 15 patients before you are comfortable with the technique.
The new vNotes technique combines the advantages of vaginal and laparoscopic operations. This approach does not require abdominal incisions, since the procedure is performed entirely vaginally using a camera and a device that provides access to the uterus and ovaries.
Studies suggest patients have less pain, fewer complications and a shorter hospital stay.
A hundred operations
Gynecologist Mihnea Gangal first discovered this approach at an international conference in 2021. It was already implemented in several countries, including China, Belgium and the United States.
PHOTO MARCO CAMPANOZZI, THE PRESS
The Dr Mihnea Gangal
I thought to myself: this is so effective and beneficial for the patient that there is no reason not to get trained for it.
The Dr Mihnea Gangal
Only certain very complex cases linked in particular to cancers or endometriosis are not admissible.
After training in the United States, Dr Gangal performed his first surgeries during the pandemic. He has now done about 100. “I have a lot of requests from patients for this surgery,” he says. He can’t accept them all, as his waiting time is already a year and a half.
Notre-Dame Hospital is one of the first hospitals in Canada to use this approach regularly.
Practice dozens of times
On the second floor of Notre-Dame Hospital, colorful anatomical models designed by Dr.r Gangal are placed on a long work table. It is with this material that the specialist teaches the new approach to gynecologists from different hospitals in Quebec.
PHOTO MARCO CAMPANOZZI, THE PRESS
The Dr Gangal uses anatomical models to teach the vNotes technique to other gynecologists.
Each model corresponds to a step in the procedure. “You have to do about 30 to 40 repetitions of the same gesture to become proficient,” says Dr.r Gangal. The workshop lasts half a day.
Once the gynecologists have trained on the simulation models, he accompanies them during their first operations. “Most of my colleagues think it’s going to be easy, but there’s a learning curve and it’s relatively difficult.” If necessary, he can complete the operation himself. It takes 10 to 15 patients before you’re comfortable with the technique, he notes.
In recent months, he has traveled to Quebec City, Gatineau and Sorel to offer mentoring. His wish: that the technique spread throughout the province.
Learn more
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- 53
- Average age of women having a hysterectomy in 2023
source: RAMQ
- 76,910
- Number of women who have undergone a hysterectomy in Quebec in the last 10 years
source: RAMQ