Introducing vNotes


Johnson Memorial Health l Franklin Indiana

vNOTES (vaginal natural orifice transluminal endoscopic surgery) is an advanced minimally invasive gynecologic procedure using the vagina as a surgical access route. The vNOTES technique is most commonly used on women needing a:

  • Hysterectomy 
  • Salpingectomy
  • Oophorectomy 
  • Cystectomy

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Johnson Memorial Health Franklin Indiana

Dr. Emily Cline of Johnson Memorial Health is one of the few surgeons certified to perform this procedure in Central Indiana.

About Dr. Cline

Answers to Your Questions

What is vNOTES?

vNOTES is the next advancement in minimally invasive gynecologic surgery. It is performed by using the vagina as a surgical access route for the procedure, leaving the patient with no visible scarring.

What are the patient benefits of vNOTES?

vNOTES has been shown to provide the following benefits compared to the laparoscopic approach1:

  • Shorter hospital stay
  • Less postoperative pain
  • No visible scars
  • Faster recovery time
What procedures typically are performed using vNOTES?
  • Hysterectomy
  • Salpingectomy
  • Oophorectomy
  • Salpingo-oophorectomy
  • Cystectomy
What conditions are treated by vNOTES?

A vNOTES hysterectomy can treat the following conditions:

  • Abnormal uterine bleeding
  • Chronic pelvic pain
  • Fibroids
  • Prolapse of the uterus

vNOTES adnexal surgery can be indicated for the following:

  • Adnexal mass
  • Sterilization
  • Prophylactic ovarian cancer prevention
What surgical techniques are used in vNOTES?

vNOTES combines the benefits of the laparoscopic and vaginal approaches to gynecologic surgery using a vNOTES device known as the GelPOINT® V-Path transvaginal access platform. o vNOTES is performed by using the vagina as a surgical access route. The vNOTES device is placed through the vagina into the pelvic cavity, giving access to the uterus, fallopian tubes and ovaries.

The abdomen is inflated with carbon dioxide gas to give the surgeon the space needed to see and operate. vNOTES enables the surgeon to operate at a lower carbon dioxide gas pressure.2

Research has shown that operating at a lower pressure is associated with reduced postoperative pain.3

A high-definition camera and specialized instruments are inserted through the vNOTES device, allowing surgeons to operate with the utmost precision and visualization. Once the surgery is completed, the vNOTES device is removed and the gas is evacuated.

What surgical societies recommend vNOTES procedures?

The following surgical societies have recommended vaginal hysterectomy, whenever feasible, as the approach of choice 4,5:

  • American College of Obstetricians and Gynecologists (ACOG)
  • American Association of Gynecologic Laparoscopists (AAGL)

1 Baekelandt J. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG. 2019 Jan;126(1):105-113

2 Kaya C. et al. Conventional Laparoscopy or Vaginally Assisted Natural Orifice Transluminal Endoscopic Surgery for Adnexal Pathologies: A Paired Sample Cross- Sectional Study. Journal of Investigative Surgery. 

3 Ali IS, Shah MF, Faraz A, Khan M. Effect of intra-abdominal pressure on post-laparoscopic cholecystectomy shoulder tip pain: A randomized control trial. J Pak Med Assoc. 2016;66(10):S45-S49.

4 Choosing the route of hysterectomy for benign disease. Committee Opinion No.701. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017:129:e155-9.

5 AAGL Position Statement: Route of Hysterectomy to Treat Benign Uterine Disease. JMIG 2011 Jan;18(1):P1-3.

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