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What is vNOTES?

Vaginal hysterectomy is the recommended approach by ACOG (American College of Obstetricians and Gynecologists) and AAGL (American Association of Gynecologic Laparoscopists) whenever indicated and feasible.1,2 Despite these recommendations and supporting clinical evidence, the rate of vaginal hysterectomies has steadily declined. Some of the challenges that contribute to lower adoption of the vaginal approach include lack of visibility and reduced access to the anatomy. Access to the adnexa can be particularly challenging, with failure rates of up to 36%.3,4

vNOTES (vaginal natural orifice transluminal endoscopic surgery) modernizes vaginal surgery. New advanced access platforms enable access into the peritoneal cavity through the vagina, effectively combining the benefits of laparoscopic and traditional vaginal surgery.

See how vNOTES works

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WHAT ARE THE BENEFITS OF vNOTES?

vNOTES enhances visualization and access compared to traditional vaginal surgery:5

  • Easier identification of ureters6
  • More complete abdominal exploration
  • Greater ability to address pelvic floor support6
  • Increased ability to remove adnexa and large uteri7
  • Better ability to teach

vNOTES has been shown to provide the following benefits compared to laparoscopic surgery:

  • Less postoperative pain and analgesics8
  • Improved ergonomics for surgeons9
  • Better cosmesis6
  • Faster recovery8
  • Fewer postoperative infections10

“vNOTES solves the challenges of vaginal surgery by allowing additional visualization. It enables you to see the patient’s anatomy, as well as any scar tissue or adhesions. Also, as surgeons, we find it helps us teach our residents how to perform surgery correctly and safely.”

- Erica Stockwell, DO, MBA, FACOG
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See vNOTES Featured on ACOG TV

HOW CAN I LEARN MORE ABOUT vNOTES?

vNOTES workshops provide a comprehensive understanding of vNOTES procedural steps and instrumentation used in the treatment of benign gynecologic pathologies. The workshop includes the following:

  • Didactic lectures reviewing indications, clinical literature, anatomy, and instrument placement

  • Hands-on practicum with lifelike Simsei® tissue models to simulate vNOTES

  • Expert guidance and feedback from the faculty

  • Continued education and support after workshop completion

contact us FOR MORE INFORMATION ABOUT COURSE AVAILABILITY IN YOUR REGION


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  • Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. (2017). Obstetrics and gynecology, 129(6), e155–e159. https://doi.org/10.1097/AOG.0000000000002112
  • AAGL Advancing Minimally Invasive Gynecology Worldwide (2011). AAGL position statement: route of hysterectomy to treat benign uterine disease. Journal of minimally invasive gynecology, 18(1), 1–3. https://doi.org/10.1016/j.jmig.2010.10.001
  • Robert, M., Cenaiko, D., Sepandj, J., & Iwanicki, S. (2015). Success and Complications of Salpingectomy at the Time of Vaginal Hysterectomy. Journal of minimally invasive gynecology, 22(5), 864–869. https://doi.org/10.1016/j.jmig.2015.04.012
  • Mothes, A. R., Schlachetzki, A., Nicolaus, K., Vorwergk, J., Lehmann, T., Radosa, M. P., Mothes, H. K., & Runnebaum, I. B. (2018). LAVH superior to TVH when concomitant salpingo-oophorectomy is intended in prolapse hysterectomy: a comparative cohort study. Archives of gynecology and obstetrics, 298(6), 1131–1137. https://doi.org/10.1007/s00404-018-4909-z
  • Lee, C. L., Wu, K. Y., Su, H., Wu, P. J., Han, C. M., & Yen, C. F. (2014). Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients. Journal of minimally invasive gynecology, 21(5), 818–824. https://doi.org/10.1016/j.jmig.2014.03.011
  • Lowenstein, L., Baekelandt, J., Paz, Y., Lauterbach, R., & Matanes, E. (2019). Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament. Journal of minimally invasive gynecology, 26(6), 1015. https://doi.org/10.1016/j.jmig.2019.04.007
  • Baekelandt, J., & Cavens, D. (2016). GelPOINT (Applied Medical) is a suitable port for transvaginal NOTES procedures. Journal of Gynecologic Surgery, 32(5), 257-262. https://doi.org/10.1089/gyn.2016.0013
  • Baekelandt, J. F., De Mulder, P. A., Le Roy, I., Mathieu, C., Laenen, A., Enzlin, P., Weyers, S., Mol, B., & Bosteels, J. (2019). Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG : an international journal of obstetrics and gynaecology, 126(1), 105–113. https://doi.org/10.1111/1471-0528.15504
  • Burnett, A.F., Rojo, M.O. (2021). Vaginal Natural Orifice Transluminal Endoscopic Surgery for Gynecologic and Gynecologic Oncology Procedures. IntechOpen, 1-9. https://doi.org/10.5772/intechopen.96082
  • Housmans, S., Noori, N., Kapurubandara, S., Bosteels, J., Cattani, L., Alkatout, I., Deprest, J., & Baekelandt, J. (2020). Systematic Review and Meta-Analysis on Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Compared to Laparoscopic Hysterectomy for Benign Indications. Journal of clinical medicine, 9(12), 3959. https://doi.org/10.3390/jcm912395

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What if you could have a hysterectomy with less pain, a faster recovery and no scars?1

What is vNOTES?

You play an important role in your surgery and your recovery. Research shows that patients who know more about their surgery choices enjoy a better outcome and are happier with their results.2

vNOTES (vaginal natural orifice transluminal endoscopic surgery) is another choice to consider for your hysterectomy and other gynecologic procedures. vNOTES is a minimally invasive surgery that eliminates the need for your surgeon to make incisions in your abdomen to perform the surgery.

In the vNOTES procedure, your doctor uses specialized instruments inserted through the vagina instead of making incisions in your abdomen. This allows your doctor to gain access to the uterus and/or fallopian tubes and ovaries without any visible scarring.

Why vNOTES?

vNOTES has been shown to provide the following benefits to patients compared to the laparoscopic approach.1

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“I was really surprised when I was in recovery, because I could get up on my own and I could move and go to the restroom. The little things you don’t expect you would be able to do for a while, I was able to do very, very quickly, I mean right after surgery.”

- Brittany Villeneuve

“The vNOTES procedure and my surgeon ... made it possible for me to just have a little blip on life and just keep going, and I feel so much better after the procedure!”

- Melissa Arrowood

“The surgery started at 9 a.m. and I went home by noon that day. I was not in any pain at the hospital. I never experienced any pain with this vNOTES procedure.”

- Dawn Wagner

What should I expect with vNOTES?

BEFORE THE PROCEDURE

Your doctor will inform you of any pre-surgery testing and will provide information on eating, drinking and taking medications.

DURING THE PROCEDURE

You will be put under general anesthesia and will not feel anything during the procedure.

A small incision will be made in the vagina to help place the vNOTES device.

Your abdomen will then be filled with gas to give your doctor more space to see and operate.

Your doctor will operate with the help of a camera and instruments placed through the vNOTES device.

After your doctor has completed the surgery, the vNOTES device will be removed, the gas will be released, and your abdomen will return to normal. The internal incision will then be stitched.

AFTER THE PROCEDURE

You may be able to go home as early as the same day as your surgery.

A follow-up appointment will be scheduled a few weeks after surgery.

TALKING WITH YOUR DOCTOR

Only a trained doctor can determine whether you are eligible for a vNOTES procedure. All minimally invasive surgical procedures, including vNOTES, present risks to the patient, such as the potential for conversion to a traditional vaginal, laparoscopic or abdominal approach. These specific risks may only be evaluated in consultation with a doctor experienced in vNOTES procedures.

 
  • Baekelandt, J. F., De Mulder, P. A., Le Roy, I., Mathieu, C., Laenen, A., Enzlin, P., Weyers, S., Mol, B., & Bosteels, J. (2019). Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG : an international journal of obstetrics and gynaecology, 126(1), 105–113. https://doi.org/10.1111/1471-0528.15504
  • Emerson, J., Paquet, A., Sangha, R., & Robison, K. (2019). Gynecologic Surgical Outcomes Through the Patient's Eyes: Are Physicians Looking in the Same Direction?. Obstetrical & gynecological survey, 74(6), 351–361. https://doi.org/10.1097/OGX.0000000000000681