vNOTES Hysterectomy Offers Less Pain, No Visible Scars

We now offer a new minimally invasive option for hysterectomy procedures in Alpena. It’s called vNOTES, which stands for vaginal natural orifice transluminal endoscopic surgery. This technique has been shown to provide the following benefits to patients compared to the laparoscopic approach[i]:

• No visible scars
• Less postoperative pain
• Less pain medication
• Shorter hospital stay
• Faster recovery time

In the vNOTES procedure, we use the vagina as the route to access the uterus, fallopian tubes and ovaries, so we don’t have to make any visible incisions in the abdomen. We place a device known as the GelPOINT® V-Path transvaginal access platform through the vagina into the pelvic cavity. We then inflate the abdomen with carbon dioxide gas so we can see and maneuver well inside the pelvis. We insert a high-definition camera and specialized instruments through the access device, enabling us to operate with the utmost precision and visualization. Once the surgery is done, we remove the device and evacuate the gas.

This procedure is less invasive than abdominal laparoscopic surgery or even robotic-assisted surgery because we only have to make one tiny incision inside the vagina. The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists have recommended vaginal hysterectomy, whenever feasible, as the approach of choice.[i]^,3  However, that’s rarely been done, because of the difficulties in seeing and accessing critical anatomy through the vagina. vNOTES solves these challenges using the access device, which increases the likelihood that we can offer gynecologic procedures vaginally.

Most patients go home the same day, and their pain levels have been reportedly very tolerable and manageable. My patients also appreciate not having any visible scars after the procedure.

There may be some cases where this approach is not appropriate, such as if the uterus or other structures that need to be removed are too large to fit through the vagina. However, in cases where we can take this approach, it’s the preferred method.

The benefits of this procedure were demonstrated in a randomized, controlled trial called the HALON study. The results, published in an International Journal of Obstetrics and Gynecology, compared the vNOTES procedure to the traditional laparoscopic approach and found a reduced operating time, reduced pain, reduced use of medication, a shorter hospital stay, and a faster recovery time.¹

In the U.S., about 500,000 hysterectomies are performed each year for women with chronic pain, fibroids, heavy bleeding, endometriosis, and precancerous or cancerous tumors. Patients who are experiencing any of those conditions or who have been told they may need a hysterectomy can learn whether this procedure is an option by asking your current doctor to consult with me or by making an appointment with me directly.

Brendan R. Conboy, M.D. is an Obstetrician/Gynecologist at MyMichigan Medical Center Alpena. He sees patients in Alpena and Oscoda and performs surgeries and delivers babies at the Medical Center in Alpena. Dr. Conboy has been specially trained on the vNOTES approach to hysterectomy and other common gynecologic procedures. He has successfully completed several hysterectomies using the vNOTES procedure and is exploring the possibility of expanding this technique to other procedures in the future, such as tubal ligations, oophorectomies or removal of ovarian cysts.

[i] Baekelandt, J. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG. 2019 Jan;126(1):105-113