vNOTES is a advanced minimally invasive surgical technique, which means it typically involves smaller incisions or no external incisions at all. This results in less tissue trauma, no scarring, and potentially shorter recovery times compared to traditional laparoscopic/open surgery.

Patients often experience less postoperative pain with vNOTES because it involves no incisions on abdomen. This can lead to decreased reliance on pain medication and a quicker return to normal activities.

Many vNOTES procedures are performed on an outpatient basis or require shorter hospital stays compared to traditional surgery, which can reduce healthcare costs and inconvenience for patients.

Since vNOTES avoids external incisions, the risk of surgical site infections is typically lower than with open surgery.

The lack of visible scars associated with vNOTES can be appealing to patients, especially for procedures involving the reproductive organs or areas of the body with aesthetic concerns.

Patients may recover more quickly after vNOTES procedures, enabling them to return to their normal activities sooner.

vNOTES minimizes the risk of incisional hernias, which can occur with traditional lap/open surgery.

The absence of external incisions results in minimal to no visible scarring, which can be an aesthetic advantage.

vNOTES procedures often involve less blood loss compared to open surgery, leading to fewer transfusions and related complications.

Adhesions are bands of scar tissue that can form after surgery. Minimally invasive techniques like vNOTES may reduce the risk of adhesion formation.

• The patient is usually placed in a lithotomy position, which involves lying on their back with their legs elevated and their feet positioned in stirrups. This provides access to the vaginal canal for the surgical instruments.
• The patient is administered anesthesia, which may be general anesthesia or regional anesthesia depending on the procedure and patient preferences.

• The surgeon accesses the vaginal canal using a speculum, similar to the speculum used during a routine gynecological exam. This allows clear visualization of the cervix and the entry point into the abdominal cavity.

• A small incision or puncture is made in the vaginal fornix (the recessed area around the cervix) to provide access to the abdominal or pelvic cavity.
• A glove bag with trocars is inserted through the vaginal incision and into the abdominal cavity. The trocar serves as a conduit for the insertion of surgical instruments and a camera.

• Carbon dioxide gas may be gently insufflated into the abdominal cavity to create space and improve visualization. This is a common practice in minimally invasive surgery.
• A laparoscopic camera (endoscope) is inserted through the trocar and positioned within the abdominal cavity. This camera provides a clear view of the surgical area on a monitor.

• The surgeon uses specialized laparoscopic instruments, which are inserted through the trocar, to perform the necessary surgical steps. These instruments can include graspers, scissors, and electrocautery devices.
• The surgery is performed under the guidance of the laparoscopic camera, allowing the surgeon to see and manipulate internal structures.

• At the conclusion of the procedure, the instruments and camera are removed.
• If necessary, the small vaginal incision is closed with sutures or other closure methods.

• After the surgery, the patient is monitored in the recovery area and may be discharged on the same day or the following day, depending on the procedure and the patient's condition.
• Patients may experience minimal to no postoperative pain, and recovery times are generally shorter compared to traditional lap/open surgery.

It's important to note that vNOTES procedures can vary in complexity and duration, depending on the specific surgery being performed. The choice of vNOTES as the surgical approach is determined by the surgeon based on surgeon expertise in vNOTES, the patient's condition and the feasibility of performing the procedure through the vaginal canal. Patients should consult with experienced surgeon to get real benefit of the procedure.