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Learn everything about vNOTES with more than 30 different video tutorials.

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Learn everything about vNOTES with more than 30 different video tutorials

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vNOTES (transVaginal Natural Orifice Transluminal Endoscopic Surgery) is a long complicated medical acronym simply meaning: surgery leaving no visible scarring.

In the past most gynaecological operations were performed through a large incision in the abdominal wall. In the last 30 years this open surgery technique has been replaced by laparoscopic or keyhole surgery: operations performed through a number of smaller incisions in the abdominal wall.

vNOTES is the next evolution in gynaecological surgery and enables surgeons to perform nearly all gynaecological operations without making any abdominal incisions. We can finally give our patients the gift of having no visible scars at all. Instead of making abdominal incisions, vNOTES operations are performed through the vagina using an endoscopic camera and microsurgical instruments.

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The OR-app will teach you everything you need to know about vNOTES. There are 3 different teaching modules with more than 30 tutorial videos teaching all the steps of vNOTES surgery.

You can watch the procedures from different camera angles to simultaneously see the surgeon’s hand movements, the vNOTES view, and an extra laparoscopic view. Animated videos are used to give you detailed explanations.

OR-app keeps you up to date with the latest scientific evidence about vNOTES research and about relevant international meetings. OR-app gives you access to a large international prospective complication database on vNOTES.

You can also find information about the history of vNOTES, the different procedures and their benefits.

Hysterectomy

Hysterectomy is a surgical procedure to remove the uterus. There are several reasons for hysterectomy, cancerous and non-cancerous, including: heavy or irregular menstrual bleeding, uterine fibroids, enlarged uterus, prolapse of the uterus, pelvic inflammatory disease (PID, pain.

There are 5 different surgical approaches to hysterectomy:
  • Abdominal Hysterectomy performed under direct vision using conventional surgical instruments through a large incision in the abdominal wall.
  • Vaginal Hysterectomy performed under direct vision using conventional surgical instruments through the vagina.
  • Laparoscopic Hysterectomy performed under endoscopic (enlarged) vision using microsurgical instruments, through a number of small incisions in the abdominal wall.
  • Robotic Hysterectomy similar to Laparoscopic Hysterectomy but performed robotically under endoscopic (enlarged) vision using microsurgical instruments through a number of small incisions in the abdominal wall.
  • vNOTES Hysterectomy performed under endoscopic (enlarged) vision using microsurgical instruments through the vagina. vNOTES combines the advantages of endoscopic surgery (improved visibility and microsurgical instruments) with the less traumatic trans vaginal approach.

Almost all hysterectomies can be performed via vNOTES leaving no visible scars.

A double blind randomised controlled trial (HALON trial) indicated that when compared to laparoscopic hysterectomy, patients undergoing a vNOTES hysterectomy have less postoperative pain, a shorter narcosis, have less complications, and choose to leave the hospital quicker.

Ovariectomy

Ovariectomy is a surgical procedure to remove the ovary. There are several reasons to perform an ovariectomy including: prophylactically, for non-cancerous, and for cancerous indication.

Ovaries are often removed prophylactically in patients with increased ovarian cancer risk (e.g. genetic mutations); in most patients this can be performed via vNOTES leaving no visible scars. Most ovariectomies for non-cancerous indications (e.g. ovarian cysts) can be performed via vNOTES leaving no visible scars. It is not advisable to treat ovarian cancer via vNOTES.

Salpingectomy

Salpingectomy is a surgical procedure to remove the Fallopian tube. There is sound evidence that removing the Fallopian tubes reduces the risk of developing ovarian cancer by 50%. Salpingectomies are performed for sterilisation or for the treatment of an ectopic pregnancy. Most salpingectomies can be performed via vNOTES leaving no visible scars.

Ovarian Cystectomy

Ovarian cystectomy is a surgical procedure to remove a cyst from an ovary, in order to preserve the ovary. The reason to perform an ovarian cystectomy is the presence of a non-cancerous cyst of the ovary. Not all ovarian cysts require surgical removal. A cyst may require surgical removal in cases where it: is large, is growing, does not look like a functional cyst on ultrasound, persists through two or three menstrual cycles, is a risk for ovarian torsion, or causes pain or other symptoms. Most ovarian cystectomies can be performed via vNOTES leaving no visible scar.

Adnexectomy (or Salpingo-oophorectomy)

Adnexectomy is a surgical procedure to remove the ovary. There are several reasons to perform an adnexectomy including: prophylactically, for non-cancerous, and for cancerous indication.

Adnexae (ovaries and Fallopian tubes) are often removed prophylactically in patients with increased ovarian cancer risk (e.g. genetic mutations); in most patients this can be performed via vNOTES leaving no visible scars. Most adnexectomies for non-cancerous indications (e.g. ovarian cysts) can be performed via vNOTES leaving no visible scars. It is not advisable to treat ovarian cancer via vNOTES.

Ectopic pregnancy

An ectopic pregnancy is a pregnancy that is not growing in the uterus. As it is dangerous for a patient to have a pregnancy grow outside the uterus, an ectopic pregnancy requires treatment. In most cases this treatment is surgical and can be performed via vNOTES without any visible scars.

Myomectomy

A myoma or fibroid is a common and benign tumor of the uterus. In many patients fibroids do not require (surgical) treatment and can be followed up. In some patients fibroids need to be surgically removed. Fibroids are classified type 0-7. Fibroids type 0-2 can be removed hysteroscopically: this is a minimally invasive transvaginal approach. Type 3-7 fibroids were traditionally resected laparoscopically through a number of abdominal incisions. In the hands of an experienced vNOTES surgeon, some of these type 3-7 fibroids can now be removed via vNOTES without visible scars.

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iNOTESs

The international NOTES Society is committed to research in and teaching of NOTES surgery. It connects surgeons from different speciality fields promoting the sharing of their knowledge and expertise of NOTES surgery.

The iNOTESs, based in Switzerland, developed the OR-App to teach vNOTES surgery to surgeons worldwide. As vNOTES surgery is performed endoscopically it is perfectly suited for this new App-based approach to teaching surgeons.

All vNOTES procedures are digitally recorded by a small camera that is inserted transvaginally into the abdominal camera. This footage is then used to develop visual educational material.

The teaching footage is filmed from surgery performed by international experts in vNOTES surgery. The video editing and narration is performed professionally under supervision of vNOTES experts.

Testimonials

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such as a web browser, email client, calendar, mapping program.

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Elijah Terry
CEO, Imagine Dragon Inc.

“Developing apps for mobile devices requires considering the constraints and features of these devices. Mobile devices run on battery and have less powerful processors.”

Daniel Wells
Android Developer, SW&Z

“Developing apps for mobile devices requires considering the constraints and features of these devices. Mobile devices run on battery and have less powerful processors.”

Robert Evans
SEO Specialist, Singleappel

“Developing apps for mobile devices requires considering the constraints and features of these devices. Mobile devices run on battery and have less powerful processors.”

Daniel Wells
Android Developer, SW&Z

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