V-Notes Surgery: Gynecological Surgeries with Natural Orifice Surgery via the Vaginal Route

In gynecological surgery, increasingly less invasive methods are being developed, providing patients with a more comfortable recovery period and shortening post-surgical healing times. One of these innovative methods is V-Notes (Vaginal Natural Orifice Transluminal Endoscopic Surgery), a minimally invasive approach based on endoscopic surgery through the vaginal route. V-Notes enables gynecological surgeries to be performed without any external incisions, entering through natural orifices. This method offers advantages both in terms of patient comfort and aesthetics.

What is V-Notes Surgery?

V-Notes is a technique used for performing surgical procedures through natural orifices via the vaginal route. This method combines the benefits of laparoscopy with the natural approach of vaginal surgery. In other words, without making any incisions in the abdominal wall, access is gained to internal organs through the vagina, and the necessary surgical interventions are carried out.

The fundamental principle of V-Notes is to access the uterus, ovaries, or other pelvic organs through the vaginal route to perform surgical interventions. This way, even the small incisions used in laparoscopic surgeries on the abdomen are no longer needed.

Applications of V-Notes Surgery

V-Notes surgery can be used in the treatment of various gynecological issues. Applications include:

1. Hysterectomy (Removal of the Uterus): In cases where the uterus needs to be removed, V-Notes offers a minimally invasive alternative. Access is gained to the uterus through the vaginal route, and the uterus is removed without any abdominal incisions.
2. Adnexal Surgeries (Surgeries Involving the Ovaries and Tubes): Procedures like the removal of ovarian cysts or tubes can be comfortably performed with V-Notes.
3. Endometriosis Treatment: Endometrial lesions, particularly those located in the pelvic region, can be removed using this method.
4. Myomectomy (Removal of Fibroids): Large or problematic fibroids can be removed via the vaginal route using the V-Notes technique.
5. Prolapse Surgery: In cases of uterine prolapse, V-Notes can be used to remove the uterus or correct the prolapse.

Advantages of V-Notes Surgery

V-Notes offers many advantages for both surgeons and patients. Compared to open surgery, the minimally invasive nature of this method brings numerous benefits:

1. No External Incisions: Since no incisions are made in the abdominal region in V-Notes, there is no visible scarring on the body. This is a significant advantage, especially for patients with aesthetic concerns.
2. Less Pain: This surgery, performed via the vaginal route, causes less postoperative pain as there is no interference with the abdominal muscles. Patients require fewer painkillers.
3. Faster Recovery: Recovery time is significantly faster compared to traditional surgical methods. Patients can typically return to daily activities within a few days.
4. Reduced Infection Risk: Since there are no external incisions, the risk of wound infection is minimal. The vaginal route is a natural opening, helping to minimize infection risk.
5. Shorter Hospital Stay: Patients are typically discharged within 1-2 days after V-Notes surgery, reducing hospital stay and associated costs.
6. Lower Bleeding Risk: With minimal damage to vascular structures, V-Notes results in less blood loss during and after surgery.

How is V-Notes Surgery Performed?

V-Notes surgery is performed under general anesthesia. The surgery process includes the following stages:

1. Anesthesia and Preparation: The patient is placed under general anesthesia, and the vaginal area is sterilized.
2. Use of Natural Orifice: Surgical instruments and a camera are inserted via the vaginal route. At this stage, no incision is made on the abdomen. Access is achieved to the pelvic organs through the vaginal route.
3. Surgical Intervention: After reaching the targeted area (such as the uterus, ovaries, or tubes), the necessary surgical intervention is carried out. For instance, if the uterus is to be removed, the ligaments are cut, bleeding is controlled, and the uterus is removed via the vaginal route.
4. Completion of the Procedure: Once the surgical process is complete, the vaginal area is closed, and the patient is awakened from anesthesia.

Risks of V-Notes Surgery

As with any surgical procedure, V-Notes carries some risks. However, these risks are generally low and are thoroughly discussed with patients before surgery. Possible risks include:

• Infection: Although rare, there is a risk of infection in surgeries performed through the vaginal route.
• Bleeding: Bleeding can occur during or after surgery, though the risk is quite low due to the minimally invasive nature of V-Notes.
• Organ Injury: Since the procedure is performed close to pelvic organs, there is a rare risk of injury to neighboring organs (such as the bladder or intestines).

These risks are minimized when the procedure is performed by experienced surgeons.

Who is Suitable for V-Notes Surgery?

V-Notes surgery is suitable for women with various gynecological issues. However, not every patient may be appropriate for this method. This technique may be challenging for women who have not had vaginal deliveries or patients with significant pelvic adhesions. A thorough preoperative evaluation is essential to determine the most suitable treatment method for each patient.

Postoperative Recovery after V-Notes

The postoperative recovery period is generally quick and uneventful. Patients are typically discharged the same or next day after surgery. Points to consider during the recovery process include:

• Mild Pain: Mild pain may be experienced after surgery, but this usually resolves within a few days.
• Early Mobility: Early movement after surgery improves circulation and speeds up the recovery process.
• Sexual Activity: Since the surgery is performed through the vaginal route, sexual activity is usually permitted 4-6 weeks post-surgery.

Conclusion

V-Notes is a revolutionary technique in gynecological surgery, prioritizing patient comfort. This surgical technique, free from external incisions, providing fast recovery, and minimizing aesthetic concerns, yields highly successful results when applied to the right patient group. To improve the quality of life and ensure a comfortable postoperative period, V-Notes surgery holds a prominent place in modern gynecology.

A detailed examination and evaluation are crucial in determining the most suitable treatment method for each patient. It is our responsibility to inform our patients about the advantages and risks of V-Notes to ensure informed decision-making.

Assoc. Prof. Dr. Pervin Karlı
Obstetrics and Gynecology Specialist