There are currently two Fellowship Programs offered in Obstetrics and Gynecology.ÌýFor more information on both of these Fellowship Programs please consult theÌýPGME Fellowships website.
1. Female Pelvic Medicine and Reconstructive Surgery Fellowship (Urogynecology)
Length: 2 years
Number of positions: 1
Fellowship Director: Dr. Lisa Merovitz
The MUHC Division of Urogynaecology & Pelvic Floor Reconstructive Surgery offers tertiary level care to patients with pelvic floor dysfunction. A 2-year clinical and research fellowship training program was initiated in 2013 in Female Pelvic Medicine and Reconstructive Surgery and was designed to provide comprehensive understanding of female pelvic medicine. Conditions investigated and treated include urinary and fecal incontinence, pelvic organ prolapse, urogenital fistulae, pelvic visceral pain syndromes (particularly interstitial cystitis and myofascial pain), and voiding and sexual dysfunctions.ÌýThe fellow attains awareness of pelvic floor anatomy, physiology, and the diagnostic criteria and pathophysiology of various aspects of pelvic floor dysfunction. ÌýManagement of pelvic floor dysfunction is carried out in a multidisciplinary fashion with involvement from members of the Divisions of Urology, Colorectal Surgery, and Pelvic Floor Physiotherapy.ÌýSurgical expertise is gained in laparoscopic approaches (sacral colpopexy/hysteropexy, total hysterectomy, uterosacral/paravaginal suspensions), incontinence proceduresÌý(mid-urethral slings, pubovaginal slings, periurethral bulking), vaginal approaches (hysterectomy, colporrhaphies, vaginally- assisted laparoscopic sacral colpopexy, transvaginal mesh systems, fistulae repair, sphincteroplasty, sacrospinous suspensions), cystoscopy (ureteral catheterization, Botox injection), and intraoperative injury prevention and management. Modalities offered include consultation services, pessary fitting, indications for and interpretation of multichannel urodynamic studies, outpatient cystoscopy, bladder installation therapy, behaviouralÌýmodification, pharmacotherapy, and levator ani assessment. ÌýResearch projects are facilitated and presented.
2.ÌýMinimally Invasive Gynecologic Surgery
Fellowship Co-Directors: Drs. Srinivasan Krishnamurthy & Jessica PapillonSmith
Duration of Training: Two years
Number of positions: One
Type of fellowship: Integrated clinical & research fellowship
The Â鶹AV Fellowship in MIGS offers a balanced mix of complex gynecologic surgery through all modalities including open, laparoscopic, vaginal, and hysteroscopic approaches. Fellows will have the opportunity to develop an expertise in advanced topics such as retroperitoneal anatomy (including complete ureterolysis from brim to bladder, identification and preservation of pelvic neuroanatomy, vascular anatomy including isolation and ligation of the anterior division of the internal iliac artery), laparoscopic myomectomy, advanced endometriosis surgery (approach to the obliterated cul-de-sac, bowel endometriosis, radical resection and restoration of anatomy for fertility improvement), as well as the surgical management of pelvic infections and invasive placentation (Cesarean-Hysterectomy). Furthermore, fellows are exposed to less common procedures, such as ovarian transposition, laparoscopic and hysteroscopic repair of isthmoceles, cervico-isthmic cerclage in the pregnant and non-pregnant patient, as well as surgical management of Cesarean scar ectopic pregnancy, as examples.
The close working relationship with the Â鶹AV reproductive centre results in a high volume of hysteroscopic procedures for polypectomy/myomectomy, adhesiolysis (Asherman’s syndrome), and septoplasty/metroplasty/isthmocele repair. In addition, endometrial resections and ablations are frequently performed for the management of abnormal uterine bleeding (resectoscopic and second generation devices). Fellows will also have the opportunity to gain confidence in urogynaecologic and vaginal surgery, including hysterectomy, A/P repair, mid-urethral sling, colpocleisis, laparoscopic Burch, and sacrocolpopexy. The opportunity to gain experience in colposcopy and ultrasound is also available, should the candidate express an interest.
Finally, our team also recently started performing VNOTES hysterectomy, setting us apart from many programs in the country, providing a unique exposure to fellows training with us. Similarly, the development of our team’s specialized multi-disciplinary surgical and research-based endometriosis referral center, one of the first of its kind, will provide the MIGS fellow with a wealth of knowledge and skills to manage some of the most complex endometriosis cases in a safe, effective and evidence-based manner.
Fellows will have the opportunity to take on more of a junior attending role with the gynecology residents on service, assist in teaching core surgical objectives for both the undergraduate and postgraduate trainees, and participate in didactic lectures, wet and dry labs, as well as simulation sessions. Fellows will have the opportunity to present at Grand Rounds, journal club, and are expected to produce a research project for presentation nationally/internationally and subsequent publication in a peer-reviewed journal. Pursuit of additional higher learning (i.e. Master’s degree in education, simulation, quality improvement, health policy, global health, etc.) is encouraged but not required.
For more information, please refer to our MIGS Fellowship Program Guide
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