History and current possibilities of vNOTES in gynecology

Česká verze

Authors: J. Dvořák ; Jaromír Mašata ; T. Fučík ; Kamil Švabík
Authors place of work: Klinika gynekologie, porodnictví a neonatologie 1. LF UK a VFN v Praze
Published in the journal: Ceska Gynekol 2026; 91(3): 250-253
Category: Přehledová práce
doi: https://doi.org/10.48095/cccg2026250

Summary

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) represents a minimally invasive surgical approach that combines the principles of vaginal surgery and endoscopy, utilizing natural transvaginal access to the peritoneal cavity. This review aims to summarize the historical development of the vNOTES technique, its current indications, contraindications, safety, and clinical outcomes in benign gynecological surgery. Based on a systematic review of the available literature, current evidence suggests that vNOTES is comparable to laparoscopic approaches in terms of safety and perioperative complications in patients with benign gynecological conditions. Several studies have reported potential advantages of vNOTES, including reduced postoperative pain, shorter length of hospital stay, and faster recovery. However, the technique has certain limitations, particularly with regard to patient selection, technical complexity, and a relatively long learning curve. vNOTES appears to be a promising evolution of the vaginal surgical approach in benign gynecology, and its wider implementation requires appropriate surgical expertise and further high-quality clinical research.

Keywords:

Minimally invasive surgery – Hysterectomy – vNOTES – NOTES – benign gynecologic disease

Zdroje

1. Bueno B. First case of vaginal appendectomy. Tokoginecol Pract 1949; 8 (72): 152–158.

2. Pickett CM, Seeratan DD, Mol BW et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2023; 8 (8): CD003677. doi: 10.1002/14651858.CD003677.pub6.

3. Kalloo AN, Singh VK, Jagannath SB et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004; 60 (1): 114–117. doi: 10.1016/S0 016-5107 (04) 01309-4.

4. Lee CL, Wu KY, Su H et al. Hysterectomy by transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES): a series of 137 patients. J Minim Invasive Gynecol 2014; 21 (5): 818–824. doi: 10.1016/J.JMIG.2014.03.011.

5. Su H, Yen CF, Wu KY et al. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): feasibility of an innovative approach. Taiwan J Obstet Gynecol 2012; 51 (2): 217–221. doi: 10.1016/J.TJOG.2012.04.009.

6. Baekelandt J. Total vaginal NOTES hysterectomy: a new approach to hysterectomy. J Minim Invasive Gynecol 2015; 22 (6): 1088–1094. doi: 10.1016/J.JMIG.2015.05.015.

7. Lee CL, Wu KY, Su H et al. Transvaginal Natural-Orifice Transluminal Endoscopic Surgery (NOTES) in adnexal procedures. J Minim Invasive Gynecol 2012; 19 (4): 509–513. doi: 10.1016/J.JMIG.2012.02.005.

8. Lowenstein L, Baekelandt J, Paz Y et al. Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and apical suspension of the vaginal cuff to the uterosacral ligament. J Minim Invasive Gynecol 2019; 26 (6): 1015. doi: 10.1016/J.JMIG.2019.04.007.

9. Liu J, Kohn J, Fu H et al. Transvaginal Natural Orifice Transluminal Endoscopic Surgery for sacrocolpopexy: a pilot study of 26 cases. J Minim Invasive Gynecol 2019; 26 (4): 748–753. doi: 10.1016/J.JMIG.2018.08.009.

10. Baekelandt J. Transvaginal natural-orifice transluminal endoscopic surgery: a new approach to myomectomy. Fertil Steril 2018; 109 (1): 179. doi: 10.1016/j.fertnstert.2017.09.009.

11. Baekelandt JF, De Mulder PA, Le Roy I et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG 2019; 126 (1): 105–113. doi: 10.1111/1471-0528.15504.

12. Kapurubandara S, Lowenstein L, Salvay H et al. Consensus on safe implementation of vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). Eur J Obstet Gynecol Reprod Biol 2021; 263 : 216–222. doi: 10.1016/J.EJOGRB.2021.06.019.

13. Baekelandt J, De Mulder PA, Le Roy I et al. Adnexectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery versus laparoscopy: results of a first randomised controlled trial (NOTABLE trial). BJOG 2021; 128 (11): 1782–1791. doi: 10.1111/1471-0528.16838.

14. Lerner VT, May G, Iglesia CB. Vaginal Natural Orifice Transluminal Endoscopic Surgery revolution: the next frontier in gynecologic minimally invasive surgery. JSLS 2023; 27 (0): e2022.00082. doi: 10.4293/JSLS.2022.00082.

15. Lerner V, Stuart AE, Baekalandt J. Vaginal Natural Orifice Transluminal Endoscopic Surgery hysterectomy deconstructed: expanding minimally invasive gynecologic surgeons’ toolbox. J Gynecol Surg 2024; 40 (2): 78–99. doi: 10.1089/GYN.2023.0098.

16. Marchand GJ, Masoud AT, Ulibarri H et al. Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery vs laparoscopic hysterectomy. AJOG Glob Rep 2024; 4 (1): 100320. doi: 10.1016/J.XAGR.2024.100320.

17. Tang Y, Fang CL, Huang JR et al. Comparison of rapid recovery outcomes between vNOTES hysterectomy and laparoscopic hysterectomy: a prospective study. BMC Surg 2025; 25 (1): 189. doi: 10.1186/s12893-025-02906-9/TABLES/6.

18. Stuart A, Wagenius J, Badiglian-Filho L et al. Intra -⁠ and postoperative complications in 4565 vNOTES hysterectomies: international registry cohort study. BJOG 2025; 132 (4): 464–472. doi: 10.1111/1471-0528.18000.