Breast surgery under hypnosis: a lot of

Since 2019, surgeon Véronique Vaini Cowen has offered her patients with breast cancer to be operated on under hypnosis. Without general anesthesia. The practitioner has implemented this approach at the Hôpital Privé de Provence (HPP) in Aix-en-Provence. A practice beneficial for patients, but also teams, and even the planet.

” You are with your son and your grandson, it is a beautiful day in July, you can hear the sound of their voices, you see them, they are walking in front of you, the sky is blue, you feel a little wind on your face, the rest of the body is comfortable, your legs can take you effortlessly beyond the fields, you take a break near the refreshing water, nothing can reach you whispers Doctor Olivier Ruinet in the ear of his patient, in an alcove created under a sterile field in the shape of a hut. It is the base camp from which he will walk with Monique Malychkine, 65, in a pleasant memory that she chose with him before D-Day.

On the other side of the operating table, the surgeon, helped by the theater nurses, incises the tissues, plunges her scalpel into the patient’s breast. Then she cuts out the tumour, which will be gently removed. A sign at the entrance to the room reminds us that an operation under hypnosis is in progress, inviting colleagues and sisters to be discreet around the room. Silent, in this block immersed in an unusual calm, the team is attentive to the slightest reactions of the patient. She seems to twitch slightly? The surgeon suspends her gesture. The anesthetist reminds the patient that her son and grandson watch her overcome obstacles on her mountain path and are proud of her. Breathing resumes its calm rhythm, the intervention continues.

• Every day in France, more than 130 women learn that they have breast cancer. One in eight women will be affected in her lifetime. In 2021, 260 women with breast cancer were operated on at the HPP.

Early detection increases chances of cure

Then it’s the wake-up call. The anesthetist warns her that the walk is coming to an end, he calmly brings her back to the here and now of the operating room. The surgeon congratulates her patient. A bright smile on her face, Monique is surprised not to have realized what was happening. She gets up, the stretcher-bearers come to fetch her in a wheelchair. ” Doctor Vaini Cowen offered to operate under hypnosis, I accepted without too much hesitation. I had seen reports, I liked the ideaexplains Monique Malychkine. Because I had undergone a first breast operation under general anesthesia in 2015, and I had not tolerated the consequences very well. I am happy to have been able to benefit from this technique, and I feel very good. »

After an operation under hypnosis, patients can leave the establishment and even drive an hour after leaving the block. Under general anesthesia, they spend several hours watched in the recovery room and cannot drive for about ten hours.

• A figure: one hour of general anesthesia under a respirator is equivalent to a Paris-Marseille round trip by car in terms of greenhouse gas emissions!

Benefits for patients and medical teams

” The body of the patient under hypnosis is with me and her mind elsewhere, far from the theater, with the anesthesiologist, explains the surgeon. I feel my patient’s reactions better, the tissues do not behave the same way as under general anesthesia, and that guides me. We sometimes slow down to give him time to regain control, guided by the voice of my colleague. This can of course slightly increase the sedation if necessary. And if the patient escapes hypnosis? It is extremely rare, but when it happens, the person, who is under transfusion, is then switched very quickly under general anesthesia.

” The writer Alexandre Dumas already described an amputation under hypnosis, recalls Dr Vaini Cowen. I contacted Curie, who was a pioneer in this field. Then I launched a call to the HPP teams and discovered that three anesthetists-resuscitators had trained in hypnosis! »

Patients receive fewer products and recover faster

” Patients, who receive fewer products, recover more quickly, and are also involved in their care. Which is generally a good omen for the rest of their journey. Especially for women with breast cancerexplains Véronique Vaini Cowen. This approach also reduces the stress of the teams, who appreciate the novelty in the practices and the calm that reigns in the block.. Sophie Laussel and Jean Lacoste, director and president-director-general of the HPP, who are very favorable to innovative practices, immediately supported the doctor. ” After the training and break-in time, in a few interventions, a team will ultimately save time compared to a classic operation with passage to the recovery room “, emphasizes the surgeon.

Only light surgery operations are concerned, but the field of possible applications is vast. Many interventions, lumbar or vascular for example, could easily be performed under hypnosis. Practitioners who have taken the plunge plead for an extension of this practice. This could soon appear in the program of medical studies. ♦

Bonuses

• A new approach to care for anesthesiologists. ” The first time we heard about hypnosis, we were interested, but still suspicious. It was a bit magical. We were curious to find out what was hidden behind this practice, medically and scientifically. We inquired, we discussed with colleagues from other establishments, and we finally trained for four weeks spread over a year.

The results are truly amazing! It’s a paradigm shift and a questioning of our practices. We are indeed moving from a world of products, with a sleeping patient, to a new medical universe where the patient, guided by our voice, controls his mind. It is a challenge, and a new part of uncertainty, but well controlled and supervised. Of more than 500 operations under hypnosis that we have performed, less than ten had to be converted to general anesthesia during the procedure. This approach offers a really rich exchange with the patient. »

Dr Olivier Ruinet, anesthetist-resuscitator, Hôpital Privé de Provence (HPP).

♦ Read the article again: The atom causes cancer but also cures it

• What cost for a hospital structure? Jérôme Schweitzer, anesthesiologist, and Corinne Fize, gynecological surgeon, were interested in the economic aspect of hypnosedation for PPH. ” In a prospective, consecutive, observational study in routine care, on conizations (removal of part of the cervix). We compared 73 patients under hypnosis associated with local anesthesia with 55 patients undergoing the same surgery under general anesthesia. “, they explain.

The results are convincing. With an identical gesture and the same rate of complications and healthy margins, the intervention under hypnosedation indeed allows a saving of 160 euros per surgical act. Operating room occupancy time is identical. On the other hand, that spent in the post-intervention monitoring room is clearly reduced. The success rate is 95% (only 4 out of 73 cases of conversion to general anesthesia). ” This study shows that hypnosedation meets the requirements of controlling health costs and the development of day surgery “, underline the authors.

Source: article by Laurent Joyeux on the congress organized in Saint-Malo in June 2018 by the French Center dedicated to hypnosis and therapeutic communication (Émergences) published on www.m-soigner.com