When Dr. Breanne Mueller first heard about the vNOTES procedure boasting less painful recovery for patients after procedures like hysterectomies, she was skeptical.
Patients only needed about three hours in recovery, she was told, and they could be discharged with only acetaminophen to control the pain.
Mueller, who specializes in obstetrics and gynecology, learned about vNOTES last spring and went through training in August.
As someone who likes to watch her patients a little closer, Mueller said, her doubt lasted until she started using the procedure and her post-operation team asked what she was doing differently. They were relaying to her that patients were recovering much faster and wanted to go home within hours of surgery.
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With less pain, Mueller said, the disadvantage is that patients are more likely to do too much too fast. Ultimately, she said, they still need to remember they just had a major surgery.
Mueller practices at Sanford Aberdeen Medical Center and is one of two doctors who are vNOTES-certified in South Dakota. The other is Dr. Heather Brewer at Monument Health in Spearfish.
Mueller said more physicians in the region are going through the training as she knows of doctors in Sioux Falls and Fargo, N.D., who are in the program.
The full name of the surgery is vaginal natural orifice transluminal endoscopic surgery. Simply put, instead of making a series of small incisions in a patient’s lower abdomen, the procedure allows a trained physician to use specialized tools to access a woman’s reproductive organs through the vagina.
Mueller said the option is ideal for a hysterectomy or ovary or fallopian tube removal. In addition to a potentially less painful recovery, she said, another advantage is the lack of scars. That, she said, is because the patient doesn’t have any visible incisions, because no cuts are needed through the abdomen muscle.
For patients who have already had laparoscopic surgery, she said, vNOTES also eliminates the need to cut through existing scar tissue.
Mueller, who has been practicing for 10 years, said she’s always looking for ways to provide different and improved options for her patients. Originally from Mitchell, she said she started looking at vNOTES because she wanted to get away from the thought that unique surgeries are only available in bigger cities like Sioux Falls, Fargo or the Mayo Clinic in Rochester, Minn.
“I feel rural people deserve the same care,” she said, describing vNOTES as cutting edge yet minimally invasive.
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Mueller said that when she started working in Aberdeen, she heard time and again from patients who opted not to travel for specialized care because it wasn’t an option for them. The cost of travel or lack of reliable transportation are two reasons they deferred care. That prompted some of the specialized care now offered in Aberdeen.
The biggest challenge with vNOTES for Mueller is getting accustomed to seeing the organs from a different perspective.
She said the procedure isn’t ideal for all patients. For example, if the uterus or ovaries are too big, a different surgery will be needed, Mueller said.
Still, it’s an option that allows more procedures to be done locally.
“I love being able to offer care they maybe would have had to travel for,” Mueller said.
Mueller also certified in menopause and hormone treatments
Mueller didn’t stop with certification for vNOTES. She’s also a nationally certified menopause practitioner through the North American Menopause Society.
“With menopause and hormones there’s so much snake oil,” she said.
While the social standard is that women can just “tough it out” when it comes to menopause, Mueller said there are options that help with symptoms such as hot flashes, mood changes and night sweats.
She said she sees her certification as something that’s meeting another need in the Aberdeen area.
“Nobody told us about it,” Mueller said. “Women deserve more and better information.”