Technology
Vaginal Natural Orifice Transluminal Endoscopic Surgery
Hysterectomy is one of the most frequently performed gynaecological procedures for various uterine pathologies.
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One of the indications is utero vaginal prolapse. Signs and symptoms of uterovaginal prolapse include:
- a feeling of fullness or pressure in the pelvic area (it may feel like sitting on a ball all the time, feeling that something is coming out from the vagina, usually it’s the uterine cervix bulging out of the vagina)
- with the bladder protruding anteriorly and the rectum bulging posteriorly in the vagina causing;
- Leakage of urine
- Inability to completely empty your bladder
- Feeling of heaviness or fullness in your pelvis
- Bulging in your vagina
- Lower-back pain
- Aching, or the feeling of pressure, in your lower abdomen or pelvis
- Constipation
Uterine prolapse occurs when the muscles and tissue in the pelvis weaken. The weakness causes the uterus drop down into the vagina. Sometimes, it comes out through the vaginal opening. Nearly half of all women between ages 50 and 79 have this condition.
There are several approaches for conducting Hysterectomies, including abdominal, vaginal, laparoscopic, and robotic.
Recently, natural orifices transluminal endoscopic surgery (NOTES) has emerged as an alternative approach for conducting Hysterectomies.
vNOTES is a minimally invasive technique using natural body orifices to access the human body for surgery. The vNOTES Hysterectomy technique involves a circular incision around the cervix, anterior and posterior colpotomy allowing the surgeon to access the abdominal cavity through the vagina
The vNOTES procedure overcomes surgical and technical difficulties of conventional vaginal surgery by incorporating the advantages of endoscopic surgery.
Moreover, vNOTES uses inexpensive, reusable, handmade conventional laparoscopic instruments and avoids problems related to abdominal wall incisions and trocar-related complications.
Overall, this procedure results in high patient satisfaction, cosmetic advantages, and decreased post-operative pain.
What Does vNOTES Mean?
vNOTES (vaginal natural orifice transluminal endoscopic surgery) is an advanced minimally invasive gynecologic surgery that combines the benefits of laparoscopic and vaginal approaches to gynecologic surgery.
Which Natural Orifice is Used in vNOTES Surgery?
In vNOTES Hysterectomy or adnexal surgery (adnexectomy, cystectomy, or salpingectomy), a colpotomy in the posterior and anterior vaginal fornix is used to directly access the pelvis through the vagina.
A small vNOTES port is then placed through the vagina to enter endoscopic instruments into the peritoneal cavity to perform the same procedure that is usually done by laparoscopy. Specialized skills and state of the art equipment is prerequisite to perform this procedure.
Studies have shown that vNOTES is associated with shorter operation and briefer postoperative hospitalization. It also has the aesthetic advantage of not leaving even the smallest scars on the abdomen, compared to TLH.
Dr. Khaled Kouteich
Chair of Department of Women’s Health - Consultant Obstetrics & Gynaecology
Fakeeh University Hospital, Dubai
This kind of surgery is relatively new in the industry and this region. The first of its kind in Dubai (Hysterectomy by VNOTES access), this procedure was successfully performed at Fakeeh University Hospital by Dr. Khaled Kouteich, Consultant Obstetrics & Gynecology, on a 60-year-old woman, who returned home the next day without any complications.
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