While there are a variety of reasons for hysterectomy and techniques to perform the procedure, vNOTES is a novel approach that complements traditional surgical techniques.
Once considered a major abdominal surgery with a long recovery period, modern approaches to hysterectomy aim to complete the procedure with minimal pain, recovery time, and cosmetic effects.
“When performing a hysterectomy, our goal is to use the least invasive approach possible to achieve a quicker recovery,” says Truong Nguyen, MD, of UTMB’s Department of Obstetrics and Gynecology.
This means evaluating every patient to determine the safest, most effective approach.
The longstanding standard “open” procedure uses a large (six to 12-inch) abdominal incision to remove the uterus, and if cancer is involved, related structures as well.
Another traditional technique is to perform the hysterectomy vaginally. However, this approach is limited by the number of available surgeons trained in this technique -- a number that is decreasing with each passing day.
The third approach is laparoscopic, removing the uterus through small abdominal incisions and offering better visualization of affected structures.
vNOTES, which stands for Vaginal Natural Orifice Transluminal Endoscopic Surgery, is the newest technique offered at UTMB. It combines the laparoscopic approach with conventional vaginal surgery.
“It's like a fusion of laparoscopic and vaginal surgery, offering the best of both worlds. We are able to do the vaginal surgery but still see into the abdominal cavity with a laparoscope, without having to make an incision,” Dr. Nguyen says.
With this technology, vNOTES allows more hysterectomies to be performed vaginally, as it is safer and offers a quicker recovery, as recommended by American College of Obstetricians and Gynecologists (ACOG).
“The benefit of vNOTES is that you're able to convert some laparoscopic cases into vaginal cases, averting any abdominal incision,” Dr. Nguyen says.
Like other hysterectomy procedures, vNOTES is performed under general anesthesia. The patient is typically able to go home the same day, or within 24 hours. Because the procedure does not require an abdominal incision, there is less pain associated with the recovery, often allowing the patient to return to work and everyday activities sooner. There is also a cosmetic benefit, with no incision meaning no visible scarring.
An additional benefit is prevention of abdominal wound infection in some patients. The procedure is favorable to patients with a larger BMI or those who have had previous abdominal surgeries, who might be at risk of infection with an open surgery. In both of these situations, Dr. Nguyen explains abdominal incisions can be challenging.
Since the department began performing the vNOTES procedures about a year and a half ago, between 30 and 40 patients have undergone the procedure.
Dr. Nguyen says he can see the rate of vNOTES hysterectomies increasing as more patients become aware and more physicians are trained on the technique.
“Here at UTMB we are not only performing the surgery, but we are training our residents in this approach for the benefit of our community and future patients,” Dr. Nguyen.
 | Truong Nguyen, MD, sees patients at the UTMB Women's Health Care Clinics at the UHC in Galveston and the Clear Lake Campus. Learn more about minimally invasive gynecologic surgery at UTMB Health. |