vNOTES (Scarless Vaginal Keyhole Surgery)

vNOTES stands for vaginal natural orifice transluminal endoscopic surgery. The surgeon operates with keyhole instruments passed through the vagina instead of the abdominal wall, so there are no visible scars. It is used mainly for hysterectomy, and for removing tubes, ovaries or ovarian cysts.

Compared with standard laparoscopy, studies show less pain after surgery, a shorter stay and no abdominal wound problems. It is a newer approach with less long-term data, it is not suitable for every pelvis, and the surgeon may need to convert to laparoscopy or open surgery in a small proportion of cases.

What vNOTES (Scarless Vaginal Keyhole Surgery) involves

Under general anaesthetic you lie with your legs in supports. For a hysterectomy, the surgeon begins as in a vaginal hysterectomy: a cut is made around the cervix, and the spaces in front of and behind the womb are opened into the abdominal cavity. A soft ring with a gel cap (the vNOTES port) is placed into the vagina to seal it, and carbon dioxide gas is introduced to inflate the abdomen. A camera and two instruments pass through the cap. With a clear magnified view, the surgeon seals and divides the ligaments and vessels from below upward, and removes the tubes or ovaries if planned. The womb is delivered through the vagina, and the top of the vagina is stitched closed.

Who is a good candidate for vNOTES (Scarless Vaginal Keyhole Surgery)?

An option for women needing surgery for benign conditions whose anatomy allows vaginal access.

• Hysterectomy for fibroids, heavy bleeding or adenomyosis, with a womb that is not excessively large
• Removal of tubes and ovaries for risk reduction, or of benign ovarian cysts
• Women who have not had vaginal births, where conventional vaginal hysterectomy can be difficult
• Those keen to avoid abdominal scars and wound pain
• Obesity, where abdominal wall ports are more troublesome

It is usually not the right choice if:

• Known or suspected cancer of the womb, ovary or cervix, outside specialist studies
• Severe endometriosis obliterating the space behind the womb
• Previous rectal surgery, pelvic radiotherapy or severe pelvic infection with dense adhesions
• Women who have never had penetrative intercourse or have a very narrow vagina
• Current pregnancy

Technique options

• vNOTES hysterectomy: The most established use, with or without removal of tubes and ovaries.
• vNOTES adnexal surgery: Cysts, tubes or ovaries removed through a small cut behind the cervix, keeping the womb.
• vNOTES prolapse repair: Suspension of the vaginal vault in selected centres.
• Conventional laparoscopic or vaginal hysterectomy: Well-proven alternatives when vNOTES is unsuitable.

What happens during your treatment

A vNOTES hysterectomy takes 45 to 90 minutes under general anaesthetic. You wake with a urinary catheter and sometimes a vaginal pack, both usually removed within hours. Many women go home the same day or after one night.

Preparing for your trip

Plan for 5 to 7 days in Istanbul. Your surgeon reviews photographs and your medical history before you book, and you meet in person the day before surgery for examination, marking and consent with a professional interpreter.

• Stop smoking and nicotine at least four weeks before and after surgery; it is the single biggest avoidable cause of wound problems
• Tell the team about every medicine and supplement you take; blood thinners, some herbal products and hormone treatment may need to be paused on your doctor's advice
• Arrange for someone to travel with you or to be reachable, and keep the first days at home free of work and lifting
• Book a changeable return flight; your surgeon confirms when you are fit to fly

Recovery and results

Pain is generally mild and handled with simple tablets. Light vaginal bleeding or discharge is normal for 2 to 4 weeks. Most women resume light activity in a week and work in 2 to 4 weeks. Nothing should go into the vagina, including tampons and intercourse, for 6 to 8 weeks while the internal stitches heal. Avoid heavy lifting for 4 to 6 weeks. Flying is usually fine after 5 to 7 days.

• Back to everyday activity: 2 to 4 weeks
• When results show: Recovery of normal activity within 2 to 4 weeks
• How long they last: Permanent

Safety, risks and revision policy

Complication rates in published series are similar to or lower than laparoscopy, but long-term data are limited.

• Injury to the bladder, ureter or bowel
• Bleeding or a haematoma at the top of the vagina
• Infection of the vaginal vault or urinary tract
• Conversion to laparoscopic or open surgery, in about 1 to 3 percent
• Opening of the vaginal wound if intercourse resumes too early
• Temporary pain with intercourse; long-term sexual function appears unchanged in studies so far

Every written proposal arranged through Clinic-Y states what the clinic covers if a correction is needed. Ask for it before you book, not after.

Cost of vNOTES (Scarless Vaginal Keyhole Surgery) in Türkiye

Clinic-Y does not publish a single price for vNOTES (Scarless Vaginal Keyhole Surgery), because the honest figure depends on your case. What moves it:

• The procedure performed: hysterectomy, cyst or ovary removal
• The single-use port system
• Day case or overnight stay
• Pathology of removed tissue

Send your photographs or reports and you receive written, all-inclusive proposals from suitable teams, side by side. Reviewing your case is free.

Frequently Asked Questions