A New Breakthrough in Vaginal Surgery: V-NOTES Surgery Offers Scarless, Painless Solution to Women

At Manipal Hospital Kanakapura Road, this advanced technique was recently used to manage a challenging case of chronic tubal ectopic pregnancy in a young woman, with remarkable outcomes.

BENGALURU, India, Sept. 12, 2025 /PRNewswire/ -- Minimally invasive surgery has revolutionized the way surgical interventions are conducted in modern medicine. Offering patients less pain, shorter hospital stays, and quicker return to normal life, it has become mainstream in today's world. Among the newer advancements, V-NOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery) is a novel surgical approach in gynaecology surgery that combines the strengths of traditional laparoscopy with natural orifice surgery, resulting in a completely scarless procedure. In this procedure, surgeons enter the pelvic cavity through the vaginal route instead of making incisions on the abdomen.

34-year-old Ms. Subha (name changed) reached out to Dr. Shailaja N, Consultant - Obstetrics and Gynaecology, with complaints of intermittent vaginal bleeding for about a month. Clinical evaluations revealed a suspicious lesion near her left ovary, indicating a chronic ectopic pregnancy in the left fallopian tube. Unlike normal pregnancies, ectopic pregnancies are a serious condition where the fertilized egg implants and grows outside the uterus, most commonly in a fallopian tube.

Traditionally, such cases would have been managed with laparoscopic salpingectomy (removal of the fallopian tube); however, the surgical team led by Dr. Shailaja N recommended the V-NOTES procedure. The surgical team performed a colpotomy (opening through the vaginal wall) to access the pelvis and remove the fallopian tube.

With over 23 years of experience in performing vaginal/laparoscopic and urogynaecology surgeries, Dr. Shailaja N, noted, "We chose V-NOTES over traditional laparoscopy because it ensures better patient recovery and is almost painless. It is ideal for tubal surgeries since the tubes lie close to the pouch of Douglas, where abdominal entry becomes unnecessary. In this case of chronic ectopic pregnancy, we anticipated some adhesions (scar tissue). The tube was indeed stuck to the left lateral pelvic wall, but it was much easier to release vaginally than laparoscopically. We could also evacuate blood clots from the site, with almost no blood loss. The outcome was excellent and far superior compared to what we would have expected with traditional laparoscopy."

The procedure was smooth, with no injury to surrounding structures. By the evening of the surgery, Ms. Subha was sitting up comfortably, eating, and reporting no pain at all. Her postoperative recovery was uneventful, and she was discharged the next day in a stable condition.

For women facing ectopic pregnancies, ovarian cysts, or requiring adnexal procedures, V ‑ NOTES provides a scarless, minimally invasive solution. V-NOTES can be used along with a variety of gynaecological procedures like hysterectomy (removal of the uterus), adnexal surgeries involving the fallopian tubes and ovaries (cyst or tumour removal), surgical staging in certain cases of early-stage endometrial cancer, and more. With outcomes comparable to laparoscopy and in some cases even superior, V-NOTES can definitely redefine minimally invasive gynaecological surgery, backed by specialized training, experienced surgeons, and state-of-the-art technology.

For more information, please visit: https://www.manipalhospitals.com/kanakapuraroad/doctors/dr-shailaja-n-obg-specialist/

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