vNotes Minimally Invasive Procedure

What is a vNotes procedure?

A new minimally invasive option for hysterectomy procedures and pelvic organ conditions is available to Independence Health System patients. Known as vNOTES (vaginal natural orifice transluminal endoscopic surgery), the advanced gynecologic technique provides many benefits to female patients, including no abdominal wall incisions, which contributes to a shorter hospital stay, less postoperative pain, no visible scars, and a faster recovery time.

Currently, James Nolfi, DO, FACOOG, an obstetrician and gynecologist practicing with Independence Health System-Westmoreland area, has been specially trained on this innovative minimally invasive approach to hysterectomy and other common gynecologic procedures. Dr. Nolfi is the first physician in the health system and one of only eight in Pennsylvania to perform this technique.

At IHS, we take pride in being able to individualize our approach for each patient because we have surgeons trained in all types of hysterectomies. From vNOTES, to total laparoscopic hysterectomy, robot-assisted surgery to an open procedure, the choices are many, the experience extensive, and the patient’s best possible outcome always guides the discussion and plan of care.

What are the benefits to this approach?

Among the benefits of vNOTES is the increased opportunity to repair problems such as urinary leakage and pelvic organ prolapse vaginally. Recovery is faster and outcomes are better than traditional forms of hysterectomy.

The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists have recommended vaginal hysterectomy, whenever feasible, as the approach of choice.

How is this technique different?

The vNOTES technique, which uses the vagina as a surgical access route, is the newest approach to hysterectomy procedures. For the surgery, a vNOTES device known as the GelPOINT® V-Path transvaginal access platform is placed through the vagina into the pelvic cavity, giving access to the uterus, fallopian tubes and ovaries. The vNOTES device is the means by which the abdomen is inflated with carbon dioxide gas to give the surgeon the space needed to see and operate. A high-definition camera and specialized instruments are inserted through the device, allowing the surgeon to operate with precision and high visualization. Once the surgery is completed, the vNOTES device is removed and the gas is evacuated.

vNOTES for gynecologic applications emerged internationally in 2012, and clinical trials followed in 2016 and 2021. In the United States, the Food and Drug Administration approved the GelPOINT® V-Path transvaginal access platform for vNOTES in 2019, and the technique has grown in popularity among surgeons since 2020 as education and training courses become more widely available.