vNOTES is a way of doing keyhole surgery in the pelvis through the vagina instead of through the abdomen. It is not a different operation — it is a different route to the same one. Whether it is the right route for you depends on the operation and on what an examination finds.
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In standard laparoscopy, a camera and instruments enter through small cuts in the abdomen. In vNOTES (vaginal natural orifice transluminal endoscopic surgery) 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 combines two established approaches — vaginal surgery and laparoscopy — so the surgeon sees the pelvis on a screen while working through the vagina.
Hysterectomy — removing the uterus, with or without the tubes and ovaries. When hysterectomy is advised, and when keeping the uterus is an option, is explained on our uterine surgery page.
Ovary and tube surgery — removing an ovarian cyst, an ovary or the fallopian tubes, when the cyst is not suspected to be cancer.
Prolapse repair — supporting the top of the vagina or the uterus to ligaments inside the pelvis (uterosacral ligament suspension), as one of several ways of repairing prolapse.
vNOTES is considered when the planned operation can be done through the vagina and the examination and scans support that route.
It is usually not suitable 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. These are judged individually.
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.
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. Anything else about how your recovery may compare is discussed with you for your own operation, rather than promised here.
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 will be told at follow-up when sex and tampons can resume; that depends on how the wound has healed.
Operations are performed at our partner hospitals, Praram 9 Hospital and Vimut Hospital, not at the clinic. Which one is used depends on the operation planned, the surgeon's operating schedule and, where relevant, which hospital your insurance works with.
Assessment, planning and follow-up happen at the clinic.
Assoc. Prof. Dr. Orawee Chinthakanan (ว.33071) — urogynecologist; Female Pelvic Medicine and Reconstructive Surgery; certified in gynecological endoscopy.
Dr. Athasit Kijmanawat (ว.47942) — urogynecologist; certified in Female Pelvic Medicine and Reconstructive Surgery.
Dr. Apichaya Klaikaew (ว.48874) — urogynecologist; certified in Female Pelvic Medicine and Reconstructive Surgery.
Care is provided by the clinic's urogynecologists. Registration numbers can be checked with the Thai Medical Council. Consultations are conducted in English or Thai.
There is no incision on the abdomen. The incision is inside the vagina and is closed with stitches that dissolve.
It is a different route, not a better operation in every case, and the evidence comparing the two is still growing. Which route suits you depends on the operation and on your examination.
Not having had a vaginal birth does not on its own rule it out. The examination and scans decide whether the route is suitable.
Whether the ovaries are kept or removed is a separate decision, made with you before surgery, and it depends on your age and history.
No. Surgery is performed at a partner hospital. The clinic handles assessment, planning and follow-up.
Message us with the operation you have been advised, or your symptoms, and we will tell you whether an assessment is worth making.
This page is general information to aid understanding. It is not a diagnosis or individual treatment advice. Which option is appropriate is decided individually after examination, and results differ between individuals. Surgery is performed at a partner hospital, not at the clinic. Consultations are conducted in English or Thai. THE FIT CLINIC, 8th Floor, EM Tower, EMSPHERE, 628 Sukhumvit Road, Bangkok 10110. Open daily 10:00–19:00.