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vNOTES - Vaginal Natural Orifice Transluminal Endoscopic Surgery, is an advanced minimally invasive surgical technique that allows surgeons to perform certain procedures through the vaginal canal. It is a form of natural orifice surgery, which aims to reduce the invasiveness of surgery by accessing the abdominal cavity or other body parts through natural openings, such as the mouth, anus, or vagina, rather than making external incisions.

vNOTES can be used to treat various gynecological and abdominal conditions, including:

Hysterectomy

Removal of the uterus. This minimally invasive approach can be an alternative to traditional laparoscopic or abdominal hysterectomy.

Oophorectomy

Removal of one or both ovaries.

Salpingectomy

Removal of one or both fallopian tubes.

Pelvic organ prolapse repair

vNOTES can be used to repair pelvic organ prolapse, which occurs when the pelvic organs, such as the bladder, uterus, or rectum, sag or bulge into the vaginal canal.

Endometriosis

Surgical management of endometriosis, a condition where tissue similar to the lining of the uterus grows outside of the uterus.

Ectopic pregnancy

Surgical treatment of ectopic pregnancies, where the fertilized egg implants outside the uterus, typically in the fallopian tube.

Myomectomy

Removal of uterine fibroids, noncancerous growths in the uterus.

Tubal ligation

Sterilization procedure for permanent contraception.

Cystectomy

Removal of ovarian cysts or other cystic masses from the ovaries.

Non-gynecological

Transvaginal Cholecystectomy

Removal of the gallbladder through the vagina, a variation of vNOTES that demonstrates the potential for this technique in other surgical fields.

Appendectomy

Removal of the appendix through the vaginal canal, another variation of vNOTES that shows the adaptability of the approach.

vNOTES offers several potential advantages over traditional open surgery or laparoscopic surgery, including shorter hospital stays, reduced postoperative pain, quicker recovery time, improved aesthetic (cosmetic), Scar-Free and reduction in surgical complication when comparing with traditional invasive surgeries like laparoscopic or robotic. However, the suitability of vNOTES for a specific condition may depend on factors such as the patient's anatomy, the surgeon's expertise, and the availability of appropriate equipment. Dr Vindhya G is pioneer in the field of vNOTES and first surgeon to offer the same in South India.

Why Dr Vindhya G prefer to perform vNOTES for her Patients

Dr Vindhya G may prefer to perform Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for several reasons include:

1. Advanced Minimally Invasive Approach

vNOTES is a advanced minimally invasive surgical technique, which means it typically involves smaller incisions or no external incisions at all. This results in less tissue trauma, no scarring, and potentially shorter recovery times compared to traditional laparoscopic/open surgery.

2. Reduced Pain

Patients often experience less postoperative pain with vNOTES because it involves no incisions on abdomen. This can lead to decreased reliance on pain medication and a quicker return to normal activities.

3. Shorter Hospital Stay

Many vNOTES procedures are performed on an outpatient basis or require shorter hospital stays compared to traditional surgery, which can reduce healthcare costs and inconvenience for patients.

4. Lower Risk of Infection

Since vNOTES avoids external incisions, the risk of surgical site infections is typically lower than with open surgery.

5. Improved Cosmesis

The lack of visible scars associated with vNOTES can be appealing to patients, especially for procedures involving the reproductive organs or areas of the body with aesthetic concerns.

6. Faster Recovery

Patients may recover more quickly after vNOTES procedures, enabling them to return to their normal activities sooner.

7. Lower Risk of Herniation

vNOTES minimizes the risk of incisional hernias, which can occur with traditional lap/open surgery.

8. Better Cosmesis

The absence of external incisions results in minimal to no visible scarring, which can be an aesthetic advantage.

9. Reduced Blood Loss

vNOTES procedures often involve less blood loss compared to open surgery, leading to fewer transfusions and related complications.

10. Decreased Risk of Adhesions

Adhesions are bands of scar tissue that can form after surgery. Minimally invasive techniques like vNOTES may reduce the risk of adhesion formation.

Difference between Laparoscopy vs vNOTES

Traditional laparoscopy and Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) are both minimally invasive surgical techniques, but they differ in terms of the access points and the specific procedures they are used for. vNOTES can be considered as advanced technique among the two. Here are the key differences between traditional laparoscopy and vNOTES:

Access Point

Traditional Laparoscopy

In traditional laparoscopy, several small incisions (usually 0.5 to 1.5 cm in size) are made in the abdominal wall, typically in the lower abdomen. These incisions serve as entry points for the laparoscopic instruments and camera to enter the abdominal cavity.

vNOTES

vNOTES, on the other hand, accesses the abdominal cavity through the natural opening of the vagina. There are no external abdominal incisions involved.

Instrumentation

Traditional Laparoscopy

Laparoscopic instruments and a camera are inserted through the small abdominal and multiple incisions to perform the surgery. 

vNOTES

In vNOTES, specialized instruments and a camera are introduced through the vaginal canal to access the pelvic or abdominal organs. There are no external incisions.

Visibility

Traditional Laparoscopy

Surgeons have a clear view of the abdominal cavity on a monitor, which is connected to the laparoscopic camera.

vNOTES

The view of camera in vNOTES is obtained through the vaginal canal, which provides direct access to pelvic organs with nearer and better visibility. It may offer a unique perspective for certain gynecological procedures.

Surgical Applications

Traditional Laparoscopy

Traditional laparoscopy is used for a wide range of abdominal and pelvic procedures, including gallbladder removal, appendectomy, hernia repair, and gynecological surgeries.

vNOTES

vNOTES is primarily used for gynecological procedures, such as hysterectomy, oophorectomy, salpingectomy, pelvic organ prolapse repair, and certain endometriosis surgeries.

Scarring

Traditional Laparoscopy

Traditional laparoscopy leaves multiple small scars at the incision sites on the abdomen.

vNOTES

vNOTES leaves no visible external scars since it accesses the abdominal cavity through the vaginal canal.

Recovery

Traditional Laparoscopy

Recovery times for traditional laparoscopy vary depending on the procedure but are generally shorter than open surgery. Patients may experience some discomfort at the incision sites.

vNOTES

vNOTES is associated with potentially quicker recovery times and less postoperative pain due to the absence of external abdominal incisions.

It's important to note that the choice between traditional laparoscopy and vNOTES depends on the specific surgical procedure, the patient's anatomy, and the surgeon's expertise and the decision should be made in consultation with a qualified surgeon who can determine the most appropriate approach based on individual circumstances.

Steps performed during vNOTES procedure

As mentioned above, Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a advanced minimally invasive surgical technique that accesses the abdominal or pelvic cavity through the vaginal canal, eliminating the need for external abdominal incisions. The specific steps of a vNOTES procedure can vary depending on the type of surgery being performed and the patient's individual condition. However, here are the general steps typically adopted during a vNOTES procedure:

1. Preparation

  • The patient is usually placed in a lithotomy position, which involves lying on their back with their legs elevated and their feet positioned in stirrups. This provides access to the vaginal canal for the surgical instruments.
  • The patient is administered anesthesia, which may be general anesthesia or regional anesthesia depending on the procedure and patient preferences.

2. Vaginal Entry

  • The surgeon accesses the vaginal canal using a speculum, similar to the speculum used during a routine gynecological exam. This allows clear visualization of the cervix and the entry point into the abdominal cavity.

3. Access to Abdominal Cavity

  • A small incision or puncture is made in the vaginal fornix (the recessed area around the cervix) to provide access to the abdominal or pelvic cavity.
  • A glove bag with trocars is inserted through the vaginal incision and into the abdominal cavity. The trocar serves as a conduit for the insertion of surgical instruments and a camera.

4. Visualization

  • Carbon dioxide gas may be gently insufflated into the abdominal cavity to create space and improve visualization. This is a common practice in minimally invasive surgery.
  • A laparoscopic camera (endoscope) is inserted through the trocar and positioned within the abdominal cavity. This camera provides a clear view of the surgical area on a monitor.

5. Surgical Procedure

  • The surgeon uses specialized laparoscopic instruments, which are inserted through the trocar, to perform the necessary surgical steps. These instruments can include graspers, scissors, and electrocautery devices.
  • The surgery is performed under the guidance of the laparoscopic camera, allowing the surgeon to see and manipulate internal structures.

6. Closure

  • At the conclusion of the procedure, the instruments and camera are removed.
  • If necessary, the small vaginal incision is closed with sutures or other closure methods.

7. Recovery

  • After the surgery, the patient is monitored in the recovery area and may be discharged on the same day or the following day, depending on the procedure and the patient's condition.
  • Patients may experience minimal to no postoperative pain, and recovery times are generally shorter compared to traditional lap/open surgery.

It's important to note that vNOTES procedures can vary in complexity and duration, depending on the specific surgery being performed. The choice of vNOTES as the surgical approach is determined by the surgeon based on surgeon expertise in vNOTES, the patient's condition and the feasibility of performing the procedure through the vaginal canal. Patients should consult with experienced surgeon to get real benefit of the procedure.

Comparison of vNOTES with different procedures:


vNOTES Laparoscopy
Robotic Laparoscopy
Laparoscopy
Open Surgery
SCARS
No Visible Scars
Visible Scars
Visible Scars
Visible Scar
Incision on Abdomen
Nil
Multiple Tiny
Multiple Tiny
Large One
Most Suitable for
Gynaecological Procedures
Small parts such as neck, ear, etc
Most of the body parts
Most of the body parts
Normal Patients
The Best
OK
OK
OK
Obese Patients
The Best
Best
OK
OK
Post Operation pain
Very Less
Less
Less
High
Recovery time
Very Short
Short
Short
Very High
Risk of infection and Blood loss
Very Rare
Rare
Rare
Often
Hospital Stay
Very Low
Low
Low
High
Economical View (Tentative)
1.1X
4.0X
1.0 X
0.8 X


Contact Dr. Vindhya G for a Consultation

Ready to explore the benefits of vNOTES and get a second opinion from a trusted expert. Contact Dr. Vindhya G  today to schedule a consultation. During your appointment, she will:

  • Review your medical history and current diagnosis.
  • Discuss vNOTES as a potential treatment option.
  • Address your questions and concerns.
  • Help you make an informed decision about your healthcare.

Conclusion

Your health and well-being are priceless, and making informed decisions about your medical care is crucial. If you're facing a gynecological procedure, don't hesitate to seek a second opinion, especially one that offers innovative solutions like vNOTES. Dr. Vindhya G is at the forefront of women's healthcare, and her expertise can be a boon for women in this century. Contact her today to embark on your journey toward better health and a brighter future.

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