Transvaginal endoscopic surgery · Şişli / Istanbul
vNOTES: a transvaginal minimally invasive surgical approach
vNOTES stands for vaginal Natural Orifice Transluminal Endoscopic Surgery. It uses a transvaginal approach with endoscopic imaging and instruments for selected gynecologic operations. I offer vNOTES as one of the surgical techniques in my gynecologic practice, when clinically appropriate.
In brief: Standard vNOTES access may avoid routine incisions through abdominal skin, but this is still internal surgery. The choice depends on anatomy, the condition being treated, possible adhesions and the goals of surgery.
What is vNOTES surgery?
The surgeon gains access through an anatomically appropriate vaginal route, using endoscopic instruments and a camera to perform the planned procedure. vNOTES is particularly relevant to selected cases of hysterectomy for benign gynecologic conditions. The route used to operate is a separate decision from which organs may need removal.
Who may be suitable for vNOTES hysterectomy?
In patients for whom hysterectomy is already an appropriate treatment for a benign condition, vNOTES may be one of several potential surgical routes. Uterine size, vaginal access, suspected pelvic adhesions, previous operations, possible endometriosis, current infection, other illnesses and surgeon experience all influence selection.
Fibroids do not automatically justify removing the uterus. If future pregnancy or uterine preservation is important, alternatives such as myomectomy or nonsurgical treatment deserve a separate discussion.
vNOTES vs vaginal hysterectomy vs laparoscopy
Conventional vaginal hysterectomy is performed through the vaginal route without the same endoscopic access used in vNOTES. Standard laparoscopy accesses the pelvis using small abdominal ports. Each method has advantages and limitations; avoiding routine skin incisions does not eliminate surgical risk.
Potential advantages and safety limitations
Studies of selected benign hysterectomy cases have reported promising early pain, operative time and hospital-stay outcomes with vNOTES compared with some alternatives. These findings depend on patient selection and the expertise of the surgical team; they are not guarantees for an individual patient.
Risks may include bleeding, infection, injury to the bowel, bladder or ureter, vaginal wound problems, complications of anaesthesia and conversion to a different route. A 2026 national evidence-based guideline emphasises appropriate patient selection and experienced surgical settings.
Consultation, hospital planning and recovery
We discuss whether the uterus needs to be removed at all, alternatives, the planned operation, tissue analysis and the possibility that the surgical route may need to change. I carry out operations requiring anaesthesia in hospital conditions at Memorial Şişli Hospital. Recovery, discharge and return to exercise or intercourse vary with the actual procedure and postoperative progress.
Related techniques and patient guides
Frequently asked questions
Does vNOTES mean completely scar-free surgery?
It may avoid routine skin incisions on the abdomen, but vaginal access and internal incisions are involved. Occasionally another surgical route is needed.
Can vNOTES be used for every woman?
No. Pelvic anatomy, access, adhesions, infection risk and the specific operation determine whether it is suitable.
Is vNOTES always better than laparoscopic surgery?
No technique is best for everyone. Comparative evidence suggests advantages in selected settings, but the individual risks and alternatives must be assessed.
Does vNOTES automatically mean a hysterectomy?
No. vNOTES describes a route of endoscopic surgery. The decision to remove the uterus is a separate clinical decision.
Clinical references and editorial note
PETKOZ: vNOTES hysterectomy in benign gynecologic indications — national guideline (2026).
This page provides general patient education. It does not replace a clinical examination, imaging, anaesthetic assessment or individual informed consent. Medical content: Op. Dr. Alparslan Demir, Specialist in Obstetrics and Gynaecology.