Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES)

Advanced Gynecologic Surgery Without Visible Abdominal Scars

vNOTES, or vaginal natural orifice transluminal endoscopic surgery, is an advanced minimally invasive surgical approach that allows select gynecologic procedures to be performed through the vagina without visible abdominal incisions.

At OBGYN Nova Sky Houston Clinic, Dr. Aalipour offers vNOTES as one of his signature surgical approaches for appropriate candidates. This innovative technique combines the advantages of vaginal surgery, laparoscopy, and modern endoscopic visualization to help patients experience advanced gynecologic surgery with no visible abdominal scars, less postoperative discomfort, and a faster return to normal activities for many patients.

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What is vNOTES?

vNOTES stands for vaginal natural orifice transluminal endoscopic surgery. It is an advanced minimally invasive gynecologic surgical technique that uses the vagina as the natural access route to reach the pelvic cavity.

Instead of making visible incisions on the abdomen, the surgeon places specialized instruments and a high-definition camera through a small internal vaginal incision. This allows the surgeon to view and operate on the uterus, fallopian tubes, ovaries, and other pelvic structures with excellent visualization.

For appropriate candidates, vNOTES may offer many of the advantages patients want from modern surgery:

• No visible abdominal scars
• Less postoperative pain for many patients
• Less need for narcotic pain medication for many patients
• Shorter hospital stay or same-day discharge in selected cases
• Faster recovery compared with some traditional approaches
• Excellent visualization of pelvic anatomy
• A more cosmetic and patient-centered surgical experience

Why Dr. Aalipour Offers vNOTES

Dr. Soroush Aalipour is passionate about advanced minimally invasive gynecologic surgery. His goal is to offer patients surgical options that are effective, safe, personalized, and designed to support recovery and quality of life.

Many women are told they need hysterectomy or other gynecologic surgery but are not always offered the least invasive option available for their specific situation. Dr. Aalipour carefully evaluates each patient’s diagnosis, anatomy, surgical history, imaging, symptoms, and goals to determine whether vNOTES, laparoscopy, robotic surgery, hysteroscopy, or another approach is most appropriate.

At OBGYN Nova Sky Houston Clinic, vNOTES is not simply a procedure. It is part of a broader philosophy:

• Use advanced techniques whenever appropriate
• Avoid unnecessary abdominal incisions when possible
• Respect each patient’s recovery goals
• Explain every surgical option clearly
• Personalize the plan instead of using a one-size-fits-all approach
• Help patients feel confident, informed, and supported

What Procedures Can be Performed with vNOTES?

vNOTES may be used for several gynecologic procedures, depending on the patient’s condition, anatomy, and surgical needs.

Common vNOTES procedures include:

• vNOTES Hysterectomy: Removal of the uterus through a scarless vaginal approach without visible abdominal incisions.
• vNOTES Salpingectomy: Removal of one or both fallopian tubes. This may be performed for sterilization, risk reduction, ectopic pregnancy, or other medical indications.
• vNOTES Oophorectomy: Removal of one or both ovaries when medically appropriate.
• vNOTES Salpingo-Oophorectomy: Removal of the fallopian tube and ovary on one or both sides.
• vNOTES Ovarian Cystectomy: Removal of selected ovarian cysts while preserving ovarian tissue when appropriate.
• vNOTES Tubal Ligation / Permanent Sterilization: A minimally invasive, scarless approach for patients who have completed their family and desire permanent sterilization.
• vNOTES Treatment of Ectopic Pregnancy: For selected patients, vNOTES may be considered as a minimally invasive approach for surgical management of ectopic pregnancy when clinically appropriate.

Conditions That May be Treated with vNOTES

vNOTES may be considered for patients with certain benign gynecologic conditions, including:

• Abnormal uterine bleeding
• Heavy menstrual bleeding
• Fibroids
• Adenomyosis
• Chronic pelvic pain
• Endometriosis, in selected cases
• Ovarian cysts
• Fallopian tube disease
• Ectopic pregnancy, in selected cases
• Desire for permanent sterilization
• Need for hysterectomy without visible abdominal scars
• Need for tube or ovary removal with a minimally invasive approach

Not every patient is a candidate for vNOTES. Dr. Aalipour will review your symptoms, examination, ultrasound or imaging results, prior surgical history, and treatment goals before recommending the safest and most effective approach.

Benefits of vNOTES

For appropriate candidates, vNOTES may offer several meaningful benefits compared with traditional abdominal or laparoscopic approaches.

Potential benefits include:

• No visible abdominal scars: Because the procedure is performed through the vagina, there are no visible abdominal incisions.
• Less postoperative pain: Many patients experience less pain because the abdominal wall is not cut.
• Less need for pain medication: Some patients require less narcotic medication after surgery.
• Shorter hospital stay: Many vNOTES procedures may be performed as outpatient or short-stay surgery, depending on the procedure and patient factors.
• Faster return to normal activities: Recovery may be faster than traditional approaches for many patients.
• Improved cosmetic outcome: Because there are no visible abdominal scars, many patients appreciate the cosmetic benefit.
• Excellent surgical visualization: The use of a high-definition camera allows the surgeon to see pelvic anatomy clearly.
• A modern alternative for selected patients: vNOTES may allow some patients to avoid open abdominal surgery or multiple abdominal incisions.
• Important note: Benefits vary by patient, diagnosis, and procedure. Dr. Aalipour will discuss whether vNOTES is appropriate for your individual situation.

vNOTES VS Laparoscopic, Robotoic, and Open Surgery

Every surgical approach has advantages. The best option depends on the patient’s condition, anatomy, goals, and safety considerations.

Open Surgery:
Uses a larger abdominal incision. It may still be necessary for certain complex or high-risk situations.

Laparoscopic Surgery:
Uses several small abdominal incisions and a camera. It is minimally invasive and commonly used for many gynecologic procedures.

Robotic-Assisted Surgery:
Uses small abdominal incisions with robotic technology to improve precision and visualization. This may be helpful for selected complex cases.

vNOTES:
Uses the vagina as a natural access route and avoids visible abdominal incisions. For appropriate candidates, it may reduce postoperative discomfort and improve cosmetic outcomes.

Who May be a Candidate for vNOTES?

You may be a candidate for vNOTES if you need gynecologic surgery and want to avoid visible abdominal incisions, depending on your diagnosis and anatomy.

Dr. Aalipour will consider several factors, including:

• Reason for surgery
• Size and mobility of the uterus
• History of prior C-sections or abdominal surgery
• History of endometriosis or pelvic adhesions
• Need for removal of ovaries or fallopian tubes
• Vaginal access and anatomy
• Imaging findings
• Overall medical health
• Patient goals and preferences

Patients who may not be ideal candidates:

vNOTES may not be the best choice for every patient. Some patients may be better served by abdominal laparoscopy, robotic, hysteroscopic, or open surgeries depending on safety, complexity, anatomy, or disease severity.

The best way to know if vNOTES is right for you is to schedule a consultation with Dr. Aalipour.

How vNOTES is Performed

vNOTES is typically performed under general anesthesia, meaning you are asleep and comfortable during the procedure.

During the procedure:

• A small internal vaginal incision is made.
• A specialized access device is placed through the vagina.
• The abdomen is gently inflated with gas to create working space.
• A high-definition camera is used to view the pelvic organs.
• Specialized instruments are used to perform the surgery.
• The uterus, fallopian tubes, ovaries, or cysts are removed as appropriate.
• The access device is removed.
• The internal incision is closed.
• There are no visible abdominal skin incisions.

Recovery After vNOTES

Recovery depends on the specific procedure performed, the patient’s health, and the reason for surgery.

Most patients are able to go home the same day or after a short hospital stay, depending on the procedure and individual factors.

After surgery, patients may experience:

• Mild to moderate cramping
• Pelvic pressure
• Light vaginal bleeding or spotting
• Fatigue
• Temporary bloating
• Vaginal soreness
• Activity limitations during healing
• General recovery instructions may include:
• Avoid heavy lifting until cleared
• Avoid intercourse until cleared
• Avoid tampons until cleared
• Take medications as directed
• Walk regularly to support circulation
• Call the office for fever, heavy bleeding, worsening pain, shortness of breath, or concerning symptoms
• Attend all scheduled follow-up visits

Dr. Aalipour will provide detailed instructions based on your procedure.

Why Choose OBGYN Nova Sky for vNOTES?

Dr. Aalipour is a high-volume vNOTES surgeon with one of the most focused vNOTES practices in the region. His experience includes a broad range of vNOTES procedures, and vNOTES is a central part of his minimally invasive gynecologic surgery program.

Dr. Aalipour is recognized for his focus on advanced minimally invasive gynecologic surgery, including vNOTES hysterectomy, vNOTES salpingectomy, vNOTES oophorectomy, vNOTES ovarian cyst surgery, vNOTES tubal sterilization, and selected vNOTES procedures for ectopic pregnancy. His goal is to offer patients modern surgical options that may help avoid visible abdominal scars, reduce postoperative discomfort, and support a faster recovery when clinically appropriate.

A unique part of Dr. Aalipour’s vNOTES training and expertise is his direct mentorship by Dr. Jan Baekelandt in Belgium. Prof. Dr. Baekelandt, a gynecologic oncologist at Imelda Hospital in Bonheiden, Belgium, is internationally recognized as The world’s leading pioneers of vNOTES. He helped introduce, develop, standardize, and teach many vNOTES techniques worldwide.

Through this advanced mentorship and his own surgical experience, Dr. Aalipour brings a highly focused vNOTES skill set to patients in Houston.

At OBGYN Nova Sky Houston Clinic, vNOTES is not simply one procedure among many. It is a signature surgical focus built around precision, innovation, patient comfort, and individualized care.

“My goal is to offer each patient the safest, most advanced, and least invasive surgical option appropriate for her condition. For many women, vNOTES can provide an excellent surgical experience without visible abdominal scars.”
— Soroush Aalipour, MD, FACOG

Please check on this link to see the certified vNOTES surgeons:
https://www.vnotes.com/findasurgeon

Common Reasons Patients Ask About vNOTES

Patients often ask about vNOTES when they have been told they may need surgery for:

• Heavy periods
• Fibroids
• Adenomyosis
• Pelvic pain
• Ovarian cysts
• Need for hysterectomy
• Need for fallopian tube removal
• Desire for permanent sterilization
• History of prior surgery and concern about scars
• Desire for faster recovery
• Preference to avoid visible abdominal incisions

If you were told you need hysterectomy, ovary surgery, tube removal, or cyst removal, a vNOTES consultation can help determine whether this approach is an option.

Considering Hysterectomy or Gynecologic Surgery?

You may have more options than you realize.
Schedule a consultation with Dr. Aalipour, to learn whether vNOTES scarless gynecologic surgery may be appropriate for you.

Schedule a vNOTES Consultation
 

Phone: (713) 701-7005