The Gynaecology-Obstetrics Service of Hospital da Luz Lisboa has performed with success, in the beginning of May, the first hysterectomies (surgical removal of the uterus) through vaginal route, using the vNOTES technique. Susana Coutinho , gynaecologist specialized in vNOTES, was in charge of the interventions carried out. These first hysterectomies with vNOTES at Hospital da Luz Lisboa were followed up by Jan Baekelandt , one of the pioneers in this technique at world level and the director of the training centre of reference of Imelda Hospital (Belgium). The vNOTES minimally invasive surgical technique is indicated in situations of non-malignant disease and looks promising for interventions to the appendages (ovaries and fallopian tubes), that usually could not be done through the classical vaginal route. It is also an alternative to classic laparoscopic surgery through abdominal route. The NOTES surgery – Natural Orifice Transluminal Endoscopic Surgery – was described for he first time in 2004, for stomach endoscopy. It resorts to the natural orifices of the human body to carry out procedures in the abdominal cavity, using endoscopes, that is, devices that allow the transmission of images from the interior, the surgery being guided by video images. vNOTES is the naming of this technique through vaginal route and was performed for the first time to perform a hysterectomy in 2012. The surgery for uterus removal (hysterectomy) in situations of benign disease is usually done by abdominal route – through a large (open) incision or small orifices (laparoscopy) – or through the vagina (vaginal route), without visible scars. However, the conventional vaginal route is limited in its indications due to poor visualization of the upper pelvis and access difficulties. However, in this case the possibilities are quite limited, mostly due to a poor visualization of the upper pelvic and the difficulty of access. In comparison with laparoscopic hysterectomy, vNOTES: Leaves no visible scars; Can reduce the time of surgery, blood loss, postoperative pain and hospitalization time; Is not indicated in malignant diseases, nor when there are pelvic adhesions between the rectum, the uterus and the vagina (namely in endometriosis) or a history of rectal surgery. In comparison with hysterectomy through traditional vaginal route, vNOTES: Combines the advantages of traditional vaginal surgery and endoscopic surgery: it uses a specific entry (port) and a laparoscopy optical instrument that allows to visualize and amplify images, thus overcoming the limitations of vaginal access. The vNOTES technique can be also used in interventions only in the ovaries and fallopian tubes, that are not usually performed through traditional vaginal route, and also in the context of general surgery for cholecystectomies and appendectomies.
