Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a less invasive surgical technique used to perform gynecological procedures. Surgeons can perform procedures like hysterectomies, oophorectomies (removal of ovaries), and salpingectomies (removal of fallopian tubes) through the vagina, so they do not need to create abdominal incisions.
Sometimes, they can perform simple myomectomies to remove fibroids, but is this the best technique to use? Today, we are going to talk about the vNOTES procedure, what it is, how it works, and what would be better than a vNOTES hysterectomy when treating fibroids.
How VNOTES Surgery Works
Patients are put under general anesthesia so they will remain comfortable during the surgery. The surgeon starts the vNOTES procedure by gently inflating the patient’s abdomen with carbon dioxide gas to expand the area so they can use a tiny camera to visualize what they are doing and will have enough room to work. Then they will insert special medical instruments through the vagina to access the pelvic cavity to perform the designated procedure.
A hysterectomy performed using the vNOTES procedure is also known as a scarless hysterectomy because there are no abdominal incisions created, so there is no visible scarring left behind.
VNOTES Hysterectomy Benefits and Risks
Choosing to undergo a hysterectomy is a serious decision and one that should not be taken lightly. Regardless of the technique used, removal of the uterus has been determined to cause a variety of long-term complications. These include early menopause, change in sexual function, psychological impact, pelvic floor issues like prolapse and incontinence, and increased risk of cardiovascular disease. Therefore, it should not be performed for benign fibroid disease or adenomyosis, which is common and otherwise easily treated with UFE and UAE.
Benefits
The vNOTES procedure provides some benefits that traditional open and laparoscopic techniques do not offer, which include:
- It is called a scarless hysterectomy since the procedure is performed through the vagina and no external incisions are used.
- Patients often experience less postoperative pain compared to other surgical techniques.
- Many patients experience a shorter hospital stay and can go home within 24 hours after their surgery.
- vNOTES hysterectomy recovery time is typically much quicker, so patients can return to their normal activities sooner.
Risks
There are risks associated with any type of surgery, and according to the Obstetrics & Gynecology Journal, about 1 in 5 women who undergo a vNOTES hysterectomy experience complications. Some of the risks that are possible during or after a vNOTES procedure include:
- Nearby organs like the bladder or rectum could be accidentally harmed during the procedure.
- Excess bleeding
- Infection
- Urinary problems
Long-Term Complications
Some complications that can develop even years after the surgery include:
- Pelvic organ prolapse, which is when organs like the bladder or intestines shift from their normal position, which can happen years after the surgery.
- Urinary incontinence, which is where the patient might experience leaking urine, especially when coughing or exercising.
- Scar tissue can form inside the body and lead to chronic pain or digestive issues.
Who Is a Candidate for VNOTES Surgery?
The vNOTES technique may not be a good option for every woman, such as those with conditions like severe pelvic inflammatory disease or extensive endometriosis, or who have undergone previous pelvic surgeries. Each case is evaluated individually, based on the individual’s medical history, to determine if the procedure would be the best form of treatment for them.
Is the VNOTES Procedure a Good Treatment for Fibroids?
A vNOTES hysterectomy may be possible even if you have fibroids, but it depends on a few conditions, including:
- The fibroids are small in size.
- There are not too many fibroids, and the uterus is not seriously distorted.
- The patient does not have a history of multiple abdominal surgeries or extensive pelvic scarring.
- The uterus is still a manageable size for removal using a vaginal route.
The bigger and more complicated the fibroids issue is, the harder it would be to remove the uterus using the vNOTES technique and more likely require conversion to laparoscopy.
What Is the Best Alternative to vNOTES for Removing Fibroids?
If you are dealing with fibroids and are researching treatment options, you might have heard about a vNOTES hysterectomy, a myomectomy, or another type of surgery that would compromise or remove your uterus. Even though medical advancements have made some types of surgery less invasive than historical methods, you should know that these are not your only options.
One of the most effective and non-surgical alternatives to eliminate fibroids is uterine fibroid embolization (UFE), and it leaves your uterus intact.
Dr. John Lipman, with the Atlanta Fibroid Center, is a leading expert in this field and has performed over 10,000 UFE procedures. He is recognized globally for his expertise, and he believes that a hysterectomy should be a last resort for treating fibroids, not the first option. Many women are not informed about the UFE procedure because it is performed by an interventional radiologist, not a gynecologist, and they do not offer this procedure in their practice.
How Does UFE Work To Eliminate Fibroids?
UFE is a minimally invasive procedure where the specially trained interventional radiologist inserts a thin tube, called a catheter, into a blood vessel in your leg or wrist, and, while guided by state-of-the-art imaging technology, the catheter is guided to the locations that supply blood to the fibroids. Next, tiny particles are injected through the catheter that blocks these arteries, which cuts off the blood supply that is keeping the fibroids alive, and they gradually shrink and die.
UFE Offers Many Advantages Over Surgery
One big advantage of UFE is that it can treat all the fibroids, regardless of their size or location. Unlike some surgical techniques that might not reach deeply embedded fibroids, UFE treats them all at one time.
Another advantage is that the recovery time is usually only about a week, which lets women return to their daily activities much sooner than they would after surgery.
But the biggest advantage that uterine artery embolization (UFE) offers is that you get to keep your uterus, and it is uncompromised. This is not only critical if you desire to become pregnant someday, but it also removes the elevated risks of future complications of a hysterectomy.
The Atlanta Fibroid Center has a dedicated wall that is full of baby pictures and thank-you notes from numerous patients who have gone on to become mothers after their UFE procedure.
Where Can I Go For An Alternative To Surgery For Fibroids?
If you are looking for an alternative to surgery for fibroids, the Atlanta Fibroid Center is the premier location for treatment and is home to our most trusted experts in UFE, Dr. John Lipman and Dr. Sima Banerjee.
Dr. Lipman and Dr. Banerjee at the Atlanta Fibroid Center focus completely on helping women avoid unnecessary surgery for the treatment of fibroids and have helped thousands of women regain their quality of life.
Many women tell us they were never told about UFE by their gynecologist, but the good news is, you do not need a referral from another doctor and can refer yourself directly to our specialist fibroid center. If you desire to avoid surgery and learn more about your options, set up a consultation with the Atlanta Fibroid Center today. Our experts are ready to help you find the best solution to find relief from your fibroid symptoms.
