What's New in Operative Gynaecology? An Introduction to Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES).

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel minimal invasive technique which uses the vagina for operative entry, after which fibreoptic and endoscopic instruments are introduced to perform surgery. This approach avoids external skin incisions and has attracted the attention of both clinicians and patients. Further, compared to conventional laparoscopic surgery, patients undergoing vNOTES have lower morbidity, better cosmesis and reduced length of postoperative stay. Initially limited to hysterectomy and adnexectomy, its role has now expanded to include indications such as urogynaecology, oncology and fertility. The aim of this review is to narrate to a general medical readership what the vNOTES approach means and how this can be adopted to hysterectomy, adnexectomy and other gynaecological indications. We also assess some of the reported outcomes and highlight that further randomised control trials will help decide if this indeed becomes the preferred surgical approach. Lastly, it is crucial to stress that clinicians wishing to implement vNOTES need to undergo appropriate training and appreciate judicious governance.