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Beginning Of Transvaginal NOTES (Scarless) Gynecological Surgery In India

Monday, April 8, 2019 Women Health News
Our team has performed India’s first Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) of ovarian cystectomy and hysterectomy on 23rd March 2019 at Lifescope IVF and Endoscopy center Naval Multi Speciality Hospital Jalgaon Maharashtra.

Team included myself- Dr. Suyash Naval Dr. Sudarshan Naval Dr. Rucha Naval and Dr. Jayashree Rane. A benign right ovarian cyst was removed from one patient and uterus was removed from another patient by this novel approach of vNOTES leaving no abdominal scars to the patients. Standard laparoscopy instruments were used and both surgeries were completed with no complications. This new approach is cosmetically superior to traditional open and laparoscopic surgery. vNOTES surgery also has advantages of lesser pain postoperative faster recovery and shorter hospital stay. Also no abdominal wounds mean no wound complications like wound infection and bleeding. vNOTES hysterectomy has potential to make difficult vaginal hysterectomy easier and feasible by adding the advantages of increased space and vision of high definition endoscopy. At the same time it retains all the advantages of classical vaginal hysterectomy most important being no abdominal scar. Most of the benign gynecological surgeries can be performed by vNOTES approach. HALON trial has demonstrated that vNOTES hysterectomy is not inferior to laparoscopic hysterectomy and results in faster recovery with less postoperative pain. NOTABLE trial of vNOTES for adnexectomy is underway. However situations like severe pelvic adhesions endometriosis malignancy and active pelvic infections are currently considered as contraindications for vNOTES.

In gynaecological surgery the era of 1980s and 1990s was of paradigm shift from open surgery to laparoscopic surgery that reduced the size of incision to very minimal. In laparoscopic surgery also there has been a shift from multiport surgery to single port surgery. This evolution happened to reduce the invasiveness of surgery for reduction in surgical pain score and for better cosmetic result.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) era started in general surgery in 2000s when first NOTES appendectomy was reported from India and NOTES cholecystectomy was reported from France. In 2012 Dr. Hsuan Su from Taiwan published first transvaginal NOTES hysterectomy in gynaecology followed by reports from Belgium and China. It has been speculated that time for another paradigm shift in gynaecology from laparoscopy to NOTES approach has begun. India is now amongst first few countries to advance in this field.
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