A New Era in Women's Surgery: OU Health Pioneers Innovative vNOTES Technique

For many women, the prospect of gynecological surgery can be daunting, but a new less-invasive surgical technique now available at OU Health is transforming care for women across Oklahoma.

vNOTES (vaginal natural orifice transluminal endoscopic surgery) is a revolutionary approach that allows surgeons to perform complex gynecological procedures without any external incisions. Urogynecologist Dr. Adam Hare, M.D., assistant professor in the Department of Obstetrics and Gynecology at the University of Oklahoma College of Medicine, is at the forefront of bringing this new technique to Oklahoma women.

"vNOTES is a novel way to approach minimally invasive surgery for gynecologic conditions," Dr. Hare said. "It takes advantage of a natural opening in the body - the vagina - and we can do surgery that we would otherwise have to put incisions on the belly for."

This technique represents a significant leap forward in minimally invasive gynecological surgery. While vaginal approaches aren't new, vNOTES combines traditional methods with advanced laparoscopic instruments, offering the best of both worlds.

"We have never approached vaginal surgery with laparoscopic instruments before," Dr. Hare said. "Now we've made the leap to combine the two approaches - vaginal surgery, but with the traditional laparoscopic instruments that we would otherwise put into the belly."

Treating a Range of Symptoms Non-Invasively

The range of conditions that can be addressed using vNOTES includes hysterectomies, tubal ligations, removal of fallopian tube and ovary and various prolapse repairs.

Pelvic organ prolapse, a condition affecting up to 40% of women in the United States, is a particular focus for the vNOTES approach. Dr. Hare describes prolapse symptoms as "feeling like you're sitting on a ball or a bulge" or "the sensation of tissue falling out of the vagina." These symptoms can significantly impact a woman's quality of life, affecting everything from bladder and bowel function to sexual health.

The benefits of vNOTES over traditional laparoscopic surgery are clear.

"There's some good evidence out there that shows that compared to what we call a traditional surgery, like a laparoscopic hysterectomy, doing a hysterectomy through a vNOTES approach does lower postoperative pain scores and provides a faster return to baseline for the patient," Dr. Hare said.

For women considering their surgical options, this faster recovery time and lack of external incisions can be life changing.

"When a patient comes in and they're saying, 'This is what my gynecologist told me, or this is what I've read about,' and we say, 'Well, wouldn't you like to do all that with no incisions on the belly and a faster recovery time?' So far, the patients that we've talked to have all said, 'Yes, sign me up. That sounds great,'" Dr. Hare said.

Leading The Way in Women’s Health

OU Health's adoption of vNOTES showcases the institution's commitment to innovation and improving patient care. Dr. Hare brought the technique to Oklahoma after observing its potential during his training in Dallas. He collaborated with vNOTES manufacturers and Applied Medical to bring training to the OU Health Physicians – Women's Pelvic and Bladder Health Center.

The support from OU Health was immediate and enthusiastic. This willingness to embrace new techniques is part of what makes OU Health a leader in women's health care, Dr. Hare said.

On July 9, 2024, his team performed the first vNOTES surgery in Oklahoma, marking a significant milestone for the state.

But it's not just about being first - it's about providing comprehensive care. Dr. Hare emphasizes the importance of offering patients a range of options.

"I feel strongly that the women of Oklahoma and our patients deserve access to the latest treatment options and a physician team who can discuss which one is the best choice for each patient," Dr. Hare said. “When you come to OU Health, we have many offerings, and vNOTES is certainly one of those. But it's not the only option that we have."

This patient-centered approach extends to all aspects of care. Dr. Hare and his colleagues understand that discussing these issues can be uncomfortable for many women.

"I know women come in and they're often embarrassed and nervous," he said. "My messaging is simple. This is all we do, and we're here to make your quality of life better, and we're going to talk through your options, and we're going to give you a chance to ask questions and make sure that you feel heard."

With only 11 board-certified urogynecologists in Oklahoma, three of whom practice at OU Health, the institution is at the forefront of specialized care for women's pelvic health issues.

"We're the only training program in the state that's training the next generation of urogynecologists," Dr. Hare said. "We have the best resources and the best ability to care for women and just get these issues on the table. We let them know they have some options."

Learn more about comprehensive, multidisciplinary women’s health care and about urogynecology services at OU Health.