vNOTES Procedures: What to Know

Rochester Regional Health is pleased to offer a new method of minimally invasive surgery. Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is an option for gynecologic surgery patients to consider.

Michelle Chin, MD, is the Director of Minimally Invasive Surgery at Unity Hospital and is one of the first providers in Rochester to perform this type of surgery. Megan Carmel, MD, and Vanessa Junor, DO, are trained to perform this surgery, as well. In this article, Dr. Chin explains the procedure, its benefits, and who may be best suited for it.

The surgical process

vNOTES is a type of laparoscopic surgery, meaning a surgeon makes a small incision to access the area being operated on. A small laparoscope, fitted with a video camera and light source, is inserted into the opening so the surgical team can see inside the body on a large video monitor.

Dr. Chin (center) operates a display vNOTES device at a recent vNOTES course at Columbia Presbyterian. In laparoscopy, a tiny camera and light source inserted into the patient’s body through a small incision allows the surgical team to conduct minimally invasive procedures using special instruments via a video monitor.

Patients are placed under general anesthesia for the procedure. The surgeon then creates a single incision in the vagina near the cervix. Once the incision is made, a custom-created vNOTES device is placed through the vaginal incision. This allows the surgeon to operate on the uterus, fallopian tubes, and ovaries as needed using specialized instruments inserted through the vNOTES device.

Dr. Chin has been performing laparoscopic surgeries for decades. Several years ago, she obtained additional education on single incision laparoscopic surgery through the abdomen. Given her expertise in vaginal surgery, she decided to try vNOTES and combine her skills.

Left to right: Michelle Chin, MD; Megan Carmel, MD; Vanessa Junor, DO, pictured at the vNOTES training at Columbia Presbyterian.

“I was able to train alongside the leading experts in the field, attend conferences and lectures, and spend extensive time working on labs,” Dr. Chin said. “Now, I am thrilled to be the first provider in Rochester available to perform this procedure.”

Available procedures

vNOTES is available to be used for a variety of gynecologic procedures, including:

• Tubal sterilization
• Tubal ligation (having your “tubes tied”)
• Draining ovarian cysts
• Hysterectomy (removal of the uterus)
• Salpingectomy (removal of the fallopian tubes)
• Oophorectomy (removal of the ovaries)

Benefits of vNOTES

Compared to other surgical techniques, there are several reasons why a patient may choose vNOTES.

Shorter hospital stay: Patients who undergo surgery can be home in much less time compared to other surgeries – less than 24 hours, in most cases.

No visible scars: Other surgeries – either laparoscopic or open – leave scars that can be seen on the abdomen. In the case of vNOTES, a vaginal incision eliminates that visible scarring.

Less post-operative pain: Patients report having less pain after vNOTES procedures compared to other methods of gynecologic surgery. As a result, post-operative patients are on less pain medication for shorter amounts of time.

Faster recovery: Some patients have returned to work less than one week after having the surgery. Other gynecologic laparoscopic surgeries require 2-4 weeks of recovery time.

One factor to consider is post-operative sexual intercourse. Surgeons advise refraining from vaginal intercourse for 4-6 weeks after the surgery is completed.

Talk with your doctor

If this type of surgery is something you are considering, speak with your OBGYN provider and ask for a referral for this procedure.

“We are glad to sit down with you and talk about all of the options available to you so we can learn how to provide the best care for you,” Dr. Chin said.