Patient information
vNOTES: surgery through the vagina, without scars on your abdomen.
vNOTES stands for vaginal Natural Orifice Transluminal Endoscopic Surgery. Your surgeon operates through a small opening at the top of the vagina, using a camera and fine instruments, instead of making cuts in your abdomen.
How vNOTES works
1
You are under general anaesthesia, so you sleep during the operation.
2
The surgeon makes a small opening at the top of the vagina, behind the cervix.
3
A soft port is placed in this opening. A camera and fine instruments pass through it, giving the surgeon a clear view of your pelvis.
4
At the end, the opening is closed with dissolvable stitches. There are no wounds on your abdomen.
Which operations can be done with vNOTES?
Not every hospital offers every operation. Ask your surgeon what is possible in your situation.
- Removal of the uterus (hysterectomy)
- Removal of ovaries and fallopian tubes
- Removal of ovarian cysts
- Treatment of pelvic organ prolapse
- Certain operations for early-stage womb cancer, in specialised centres
Benefits and risks
Possible benefits
- No visible scars.
- No wounds in the abdominal wall, so no risk of wound infection or hernia there.
- In a randomised trial, 77% of women went home within 12 hours after a vNOTES hysterectomy, compared with 43% after a laparoscopic hysterectomy.
- It can be especially helpful for women with obesity, a large uterus, or scar tissue from earlier abdominal surgery.
Possible risks
- As with any operation: bleeding, infection, and injury to the bladder, bowel or ureters.
- Sometimes the surgeon has to switch to keyhole surgery or open surgery to finish the operation safely.
- Your personal risk depends on your health and the operation. Ask your surgeon about their own results.
Source: Baekelandt et al., HALON trial, BJOG 2019.
Is vNOTES suitable for me?
Many women can have vNOTES, including women who have never given birth. Your surgeon decides together with you which approach suits you best.
vNOTES is usually not advised if you have
- (Suspected) endometriosis behind the uterus
- Had surgery on your rectum
- Had a severe pelvic infection or an abscess in your pelvis
Before and after surgery
Going home
Many women go home the same day or the day after surgery.
Healing
You can walk and do light activities soon. Avoid sexual intercourse, baths and heavy lifting until your surgeon says the vaginal scar has healed, usually after about six weeks.
Contact your doctor if you have
Fever, heavy vaginal bleeding, pain that gets worse, or problems passing urine.
Questions to ask your surgeon
- How many vNOTES operations have you performed?
- Why do you recommend vNOTES for me, and what are the alternatives?
- What happens if the operation cannot be completed with vNOTES?
- How long will I stay in hospital, and when can I return to work?
- Do you register your operations, for example in the iNOTESs Case Registry?
Frequently asked questions
Is vNOTES a new technique?
vNOTES has been performed for more than ten years and is now used in hospitals around the world. iNOTESs trains surgeons and collects the results of operations to keep improving safety.
Will it affect my sex life?
Once the vaginal scar has healed, most women can have intercourse as before. Discuss any concerns with your surgeon.
Can I have vNOTES if I have never given birth?
Yes, in many cases. Your surgeon will examine you to decide whether it is possible.
How do I find a surgeon who performs vNOTES?
Use the map below. It shows surgeons who are members of iNOTESs and perform vNOTES.
Find a vNOTES surgeon near you
The map of iNOTESs member surgeons is coming soon. It will let you search by country or city.
This page gives general information and does not replace advice from your own doctor. Reviewed by iNOTESs experts, [REVIEW DATE].