Told You Need a Hysterectomy? What vNOTES Is, and Who It Suits

When a doctor says you need a hysterectomy, or an operation for an ovarian cyst, one of the first worries is the cut on your abdomen. There is more than one way to reach the same operation, and vNOTES is one of them.

vNOTES stands for vaginal natural orifice transluminal endoscopic surgery. In standard laparoscopy, a camera and instruments enter through small cuts in the abdomen. In vNOTES, the surgeon makes an incision at the top of the vagina, places a port there and passes the camera and instruments through it. There is no incision on the abdomen; the wound is inside the vagina. It is not a different operation. It is a different route to the same one.

It combines two established approaches, vaginal surgery and laparoscopy, so the surgeon sees the pelvis on a screen while working through the vagina.

It is used for hysterectomy, with or without removing the tubes and ovaries; for removing an ovarian cyst, an ovary or the fallopian tubes when the cyst is not suspected to be cancer; and as one of several ways of repairing prolapse, by supporting the top of the vagina or the uterus to ligaments inside the pelvis.

It is not suitable for everyone. It is usually not an option after previous rectal surgery or pelvic radiotherapy, where severe endometriosis has closed the space behind the uterus, during an active pelvic infection, when the uterus is very large, or when cancer is suspected. Not having had a vaginal birth does not on its own rule it out. The examination and scans decide whether the route is suitable.

vNOTES is newer than standard laparoscopy. Published studies, most of them on hysterectomy, are smaller and shorter than the evidence for established approaches, and long-term comparisons are still limited. The difference that is certain is the absence of abdominal incisions. How your own recovery may compare is something to discuss for your own operation, not something to be promised in advance.

Like any pelvic surgery, vNOTES carries a risk of bleeding, infection, and injury to the bladder, bowel, ureters or blood vessels. Sometimes the operation cannot be completed through the vagina and is changed to standard laparoscopy or open surgery under the same anaesthetic; this possibility is agreed with you before surgery. Because the wound is inside the vagina, you are told at follow-up when sex and tampons can resume.

Whether the ovaries are kept or removed at a hysterectomy is a separate decision, made with you before surgery, and it depends on your age and history.

The choice between vNOTES, standard laparoscopy, vaginal surgery without a camera, or open surgery is made with you after assessment. No single route is right for every woman. At THE FIT CLINIC, assessment, planning and follow-up happen at the clinic, and operations are performed at our partner hospitals, Praram 9 Hospital and Vimut Hospital. Results differ between individuals.