vNOTES provides women with a scarless option for fibroid surgery

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For women struggling with fibroids, the prospect of surgery has long meant scars, lengthy recovery, and time away from work. That’s beginning to change as an “incisionless” technique called vaginal natural orifice transluminal endoscopy surgery, better known as vNotes, becomes more widespread.

Unlike traditional surgery, vNOTES is done laparoscopically through the vagina with no abdominal incisions. It can be used for hysterectomy, myomectomy and removal of ovarian cysts.

Farinaz Seifi, MD, OB/GYN at the University of Maryland Medical Center, where she serves as Vice Chair of Gynecology & Gynecology Subspecialities, said that patients often go home the same day.

“Recovery may take only two to four weeks, compared to the old method which could entail a hospital stay of two to three days and require a recovery period of six to eight weeks,” she explained. “Additional benefits include fewer requirements for blood transfusions, lower postoperative pain, better postoperative recovery, no abdominal wall complications and the aesthetic advantage of no visible scars,” she added.

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What are fibroids, and who gets them?

Seifi, who is also an associate professor at the University of Maryland School of Medicine, describes fibroids as non-cancerous growths inside the uterus. “They are among the most common gynecologic conditions, but do not occur before puberty and frequency decreases with menopause,” she said.

Fibroids are widespread, according to Seifi. “Approximately 70 to 80 percent of women will develop fibroids by the age of 50. The incidence is higher in black women (80%) compared to white women (70%). Between 20-25 percent of women of reproductive age are affected and 30-40 percent of women over 40,” she said.

Fibroids may grow asymptomatically. “When systems do occur, patients can suffer from uterine bleeding, urinary or bowel dysfunction, infertility and abdominal pain,” she said.

Who qualifies for vNOTES?

According to Seifi, good candidates for the procedure include not only those who have fibroids, but also those who have heavy bleeding and other non-cancerous conditions of the uterus. The procedure can also treat ovary or fallopian tube issues such as cysts, benign growths, or fluid in the tubes.

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Other candidates are women seeking permanent birth control — since the procedure can be used to block or remove the fallopian tubes — or those who want tubes removed to reduce cancer risk.

However, not everyone qualifies. Seifi said that certain medical conditions can affect eligibility, like severe adhesions, extensive endometriosis and malignancy suspicion.

Determining if it’s right for you

Though new to many patients, vNOTES is not experimental. “The procedure was established in 2018 in Europe and there are now trained surgeons performing in the U.S., particularly in New York City,” explained Seifi. “In the state of Maryland, only a few surgeons are certified to perform vNOTES, including myself.”

Every surgery has its own risks and benefits, but with careful patient selection and counseling, Seifi noted that complications are minimal. “What matters most is the patient’s quality of life —whether they undergo vNOTES, or another procedure, my goal is always to improve how they feel and function, so the real measure of success is how the women are feeling afterwards,” she said.