vNOTES Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus partly or completely. Doctors may recommend a hysterectomy as a treatment option to help ease discomfort, pain or heavy bleeding in women with certain reproductive conditions. At DMC Huron Valley-Sinai Hospital and DMC Hutzel Women's Hospital, we offer vaginal natural orifice transluminal endoscopic surgery (vNOTES), a minimally invasive hysterectomy treatment option for eligible patients.

A minimally invasive treatment like the vNOTES hysterectomy may lead to a faster recovery, reduced pain, reduced surgical risk and shorter hospital stays when compared to traditional hysterectomy. Facing surgery might feel scary; that’s why DMC is here to ensure you’re comfortable and guide you through the vNOTES process to help you understand your treatment options.

What Is vNOTES Hysterectomy?

In a traditional hysterectomy, the surgeon removes the uterus through large incisions in the abdomen. Another approach to a hysterectomy is to perform it vaginally (wherein the uterus will be accessed through the vagina instead). A vaginal hysterectomy eliminates the need to make abdominal incisions. Vaginal hysterectomy procedures are the recommended approach by the American College of Obstetricians and Gynecologists (ACOG), American Association of Gynecologic Laparoscopists (AAGL), Cochrane and International Society for Gynecologic Endoscopy (ISGE) for certain conditions.

vNOTES is a minimally invasive gynecologic surgery most commonly used for hysterectomy. It can also be used for uterosacral ligament suspension, adnexal procedures and other procedures. vNOTES is also a type of laparoscopy wherein a small laparoscope (tube-like instrument equipped with a camera and lighting) is inserted into the patient’s body so the surgical team can clearly see inside the surgical site on a video monitor. Not all patients may qualify for vNOTES, so talk to your doctor about whether it’s an appropriate treatment for your condition or if they recommend an alternative treatment option.

What Are The Different Kinds of Hysterectomy?

Your doctor will discuss which hysterectomy type may be appropriate for your condition. Types of hysterectomy may include:

Total hysterectomy – removal of the uterus and cervix, but not the ovaries.
Hysterectomy with oophorectomy – removal of the uterus, one or both ovaries and sometimes the fallopian tubes.
Radical hysterectomy – an option for treating cancer; this procedure involves removing the uterus, cervix, top portion of the vagina, most tissues surrounding the cervix and sometimes pelvic lymph nodes.
Supracervical hysterectomy – removal of the uterus while leaving the cervix intact. This can be a treatment option for endometriosis, fibroids or other noncancerous conditions.

Why Is a Hysterectomy Needed?

Common conditions that may require vNOTES surgery may include:

Unusual or heavy vaginal bleeding
Uterine prolapse – the uterus slips from its original position down into the birth canal.
Endometriosis – tissue typically found in the uterus grows outside of it.
Cancer or precancer – hysterectomy may be the best treatment option if a patient has been diagnosed with cancer or precancer in the uterus, cervix, ovary or endometrium (uterine lining).

Keep in mind that there may be alternative ways to treat your health problem without having a hysterectomy. Hysterectomy is a major surgery. Talk with your doctor about all of your treatment options.

The Surgical Process

Before the vNOTES procedure, your doctor will perform several pre-surgery tests and give instructions on eating, drinking and consuming medications.

You will be put under general anesthesia so that you will be asleep throughout the procedure.
The surgeon makes a small incision in the vaginal wall.
A custom-made vNOTES device is placed through the incision. Specialized surgical instruments are inserted through the device.
The surgeon uses these devices to operate on the organs that need removal.
The surgeon inspects the surgical site before removing the vNOTES device and stitching the surgical incision close.

Most patients may be able to go home the day of the surgery, but hospital stays may last up to two days. Your doctor may encourage you to move around as soon as possible after your surgery.

What Is the vNOTES Hysterectomy Recovery Time?

Recovery from the vNOTES hysterectomy procedure may take three to four weeks, though the actual time it takes for you to recover will depend on your surgery and pre-surgery health. Your doctor will instruct you to get plenty of rest. You should also avoid lifting heavy weights for up to six weeks after your procedure. Make sure to attend your follow-up appointments so your doctor can check how you’re recovering.