There are two research areas within this domain:
- Pelvic Floor
- Uterine Health
1. PELVIC FLOOR
Examines the underlying reasons why pelvic floor disorders develop and looks at the effect of pregnancy, labour and birth.
For example: Ultrasounds and MRIs have added greatly to our understanding of female pelvic floor anatomy and the changes in anatomy associated with disorders; their origination and progression. We are studying the anatomical, biomechanical bimolecular and genetic basis for these disorders.
Evaluates the merits of various treatments.
Using database analysis, we evaluate the relative merits of both surgical and medical treatments.
For example: 30% of women having surgery for pelvic organ prolapse need a second operation. We are using dynamic MRI, a new technology, to develop a better understanding of the anatomic changes in recurrent pelvic organ prolapse to identify any predisposing factors that may predict a reoccurrence.Our genetic, biomechanical and biomolecular studies increase our understanding of the pathologic physiology of these conditions and the limitations of our treatments. We are examining the relative merits of drug therapies used to treat urinary incontinence vs. surgical and other treatment options.
Develops clinical tools to assess the risk of developing a disorder, to determine the most appropriate preventative strategy, to measure the severity of disorders and to chart their progress so that treatment can be appropriately tailored to the condition.
For example: We are promoting a standardized approach in the assessment of urinary incontinence- a pathway of care that will operationalize the national standards of care. We want to be sure that women presenting with certain symptoms are treated uniformly in other words all are given the same baseline tests and then triaged into a different series of tests as their results dictate. By establishing a uniform approach it will then be possible to better evaluate the effectiveness of one treatment over another. Once this pathway is finalized it can be documented and published so that other centers in Canada can incorporate it into their practices. If all centres use a similar approach, research will be more easily facilitated with increases in reliability and validity.
Creates advanced surgical technology using robotics to improve treatment for situations involving surgical reconstruction.
For example: We were the first in Canada to do a robotically assisted total laparoscopic hysterectomy. Use of robots improves precision of laparoscopic surgery and allows surgeons to complete more complex surgery as the robots facilitate a more "wrist ed" motion than the long rigid shafts of the more traditional laparoscopic instruments. Patient recovery times are also faster as the surgery is much less invasive.
Stimulates research interest in this area by faculty and trains other physicians to use these advanced techniques.
2. UTERINE HEALTH
Improves the efficacy of laparoscopic surgery
For example: Sixty percent of complications are related to initial entry into the abdomen. Research led to the development of a new technique known as the ABC of laparoscopic entry which is an easier and safer entry than previous methodologies. It has been adopted as a National Guideline for Canada.
Reduces the need for hysterectomies
One third of women will have a hysterectomy by the age of 60. Less than 10% of these hysterectomies are related to cancer-most are related to one of three benign causes fibroids, menstrual disorders which lead to abnormal bleeding and endometriosis which leads to chronic pelvic pain. Our research focused on addressing each of these causes to try and develop methodologies to reduce the rate of hysterectomies. As a result of these initiatives the hysterectomy rate in Canada has been reduced by at least 50%.
For example: We have introduced novel ways to treat fibroids. The first is based on occlusion, which deprives the fibroid of its blood supply and thus causes it to die and shrink. Three different techniques have been created to perform an occlusion. The second way to treat fibroids is based on medication and uses a medicated intrauterine device to shrink the fibroids and decrease bleeding. This work on occlusion won first prize at the Society of Gynaecologists and Obstetricians in June 2008. To address excessive bleeding we have pioneered in Canada use of an endometrium oblation, which is a procedure to deliberately eliminate the lining of the uterus using a vaginal entry. This technique has evolved over the last 20 years to become a two-minute procedure conducted in a clinic using a hot liquid balloon. The second method developed s involves inserting an intrauterine device that releases medication to shrink the lining. This procedure is reversal. We also introduced to Canada laser treatment for endometriosis.
Explores methodologies and treatments for tubal ligations
For example: This new area of research has a goal of creating a technique that is based on vaginal entry and utilizes small telescopes and instruments. Among other benefits, this will improve patient recovery time from approximately one week to going home/back to work in thirty minutes.
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