What if you could have surgery with no scars?

Photo caption: Dr Bob Achila (3^rd left), Consultant Urogynaecologist at Aga Khan University Hospital with the theater team including fellow doctors, nurses, theatre assistants and technologists that was involved in conducting a new surgical technique called vNOTES.

You play an important role in your surgery and your recovery. Research shows that patients who are well informed about their treatment options enjoy a better outcome and are more

satisfied with their results. vNOTES (vaginal natural orifice transluminal endoscopic surgery) is another option to consider for your gynaecological surgeries. It is the next advancement in minimally invasive surgery and does not require abdominal skin incisions. This technique is now available locally at Aga Khan University Hospital and has been performed successfully by a team that I have led.  Here's more to this technique and how it's beneficial to women requiring gynaecological surgeries.

What is vNOTES?

vNOTES, short for vaginal natural orifice transluminal endoscopic surgery, is an advanced surgical technique where operations are performed through the vagina, eliminating the need for visible abdominal cuts. In this procedure, surgeons use specialized instruments inserted through the vagina instead of making incisions in the abdomen.

What does this procedure entail – what will the doctor do?

In the vNOTES procedure, your gynaecologist uses specialized instruments inserted through the vagina instead of creating visible abdominal incisions in the body. This allows your doctor to gain access to the uterus and/or fallopian tubes and ovaries without any visible scarring

What women's conditions can be operated on using vNOTES?

vNOTES is effective for various conditions, including hysterectomy, surgeries on the fallopian tubes and ovaries (such as ovarian cysts, ectopic pregnancies, and permanent sterilization), and pelvic organ prolapse. As gynaecologists gain more experience with this technique, its applications are expanding.

Before vNOTES, what approach was being used?

Before vNOTES, traditional open surgery with larger abdominal incisions or laparoscopic surgery with smaller cuts was commonly used.

What's the difference between vNOTES and minimally invasive surgery?

While both vNOTES and minimally invasive surgery aim to minimize scarring and speed up recovery, vNOTES achieves this by avoiding any external cuts, operating solely through the vagina, whereas minimally invasive surgery involves small abdominal incisions.

What advantages are associated with vNOTES?

Compared to laparoscopic surgery, vNOTES offers several benefits: no visible scars, a shorter hospital stay, reduced post-operative pain, quicker recovery, and less reliance on pain medication.

How long has this expertise existed globally, in Africa, and the East Africa region?

vNOTES has been in use worldwide for about ten years. In Africa, including East Africa, it's a relatively new technique but is slowly becoming more prevalent as medical professionals gain expertise.

As a patient, what risks should I be aware of before going in for this procedure?

As with any surgery, vNOTES carries some risks, such as infection, bleeding, or possible injury to nearby organs, though these complications are generally uncommon.

What expertise is required for doctors who conduct this operation?

Doctors who perform vNOTES need to be specially trained in both minimally invasive surgery and the specific techniques required for vNOTES.

Approximately how long will the procedure last?

The duration of the procedure depends on the condition being treated but usually takes between one to three hours.

Can I go home on the same day of the operation?

Yes, many patients can go home the same day, though some may need to stay in the hospital overnight.

How fast can I return to normal life and activities after undergoing vNOTES?

Recovery is typically swift, with many patients resuming their usual activities within a week or two, though full recovery might take a bit longer.

What follow-up care is involved after this procedure?

After the surgery, follow-up care generally includes routine check-ups to ensure proper healing. Patients may also need to avoid heavy lifting or strenuous activities for a short period.

By Dr Bob Achila, Consultant Urogynaecologist at Aga Khan University Hospital, Nairobi