An innovative gynecological surgical technique is performed in Puerto Rico

It is a novel surgical technique, minimally invasive, and that allows women who need it to have a faster recovery time than traditional surgeries, a shorter hospital stay, less pelvic or post-surgical pain, and no scarring on the abdomen.

It’s what you get with the novel vNotes procedure (natural vaginal orifice transluminal endoscopic surgery) which was used for the first time on the island in the Mutual Aid Hospital. In fact, the first interventions with this innovative technique were carried out on the island by Dr. Miguel A. Vázquez Guzmán Along with Dr. Dani Zoorob, who traveled from Miami to finish the medical certification of the obstetrician-gynecologist.

“Transluminal endoscopic surgery, which is performed through natural orifices or vNotes, offers new ways of approaching the abdominal cavity with potential advantages over conventional laparoscopic surgery,” explains Dr. Vázquez Guzmán.

According to the specialist, it is a technique that allows taking advantage of the vaginal cavity instead of creating incisions in the abdomen, which allows different gynecological procedures to be carried out that are minimally invasive. Among them, he mentions hysterectomies, removal of ovaries and fallopian tubes.

“It has several advantages for patients who have undergone surgery, including a faster recovery as it is an outpatient procedure and less pain, thus reducing the use of analgesics,” adds the also urogynecologist.

One of those who benefited from this technique is the manicurist Ruth Sierra Montañez, from Juncos, who had very heavy bleeding during her menstruation, as well as a lot of pain. “Initially they were going to do a traditional laparoscopic surgery. But the doctor offered me this new option and I said yes because it was less invasive, there was no pain and the hospital stay was shorter”, says the patient in a telephone interview.

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Illustration of transluminal endoscopic surgery, which is done through natural orifices or vNotes. (Supplied)

The 52-year-old woman, who underwent surgery on June 28, admits that at first she was a little scared because it was a relatively new technique. But she indicates that she had had a bleeding problem for almost a year and a lot of pain in her menstruation, so she agreed to have surgery and has no regrets. After the surgery she had no pain and now, more than three weeks after the surgery, she says she feels very well.

“I work with women all the time and (I had seen that) some recoveries from traditional laparoscopic surgery, which is what they do by cesarean section, was more than a month. That’s why, when the doctor told me about the benefits of this technique, I agreed. And from day one that I had the surgery I felt fine, without pain”, reiterates Ruth.

As Dr. Vázquez Guzmán explains, To carry out an operation with vNotes, it is necessary to use a special device that allows the laparoscopy to be installed vaginally and that replaces the access tubes to the abdominal wall. p“For surgeons who are certified in this technique, it is easy to adapt and work without any increase in intervention times”.

But the biggest benefit, the obstetrician reiterates, is that patients recover much faster, compared to traditional laparoscopic surgery.

“It’s a vaginal laparoscopy. During the procedure, the blood loss is much less than in traditional surgeries, without incurring much post-surgical pelvic pain, in addition to the fact that the patient does not have scars on her abdomen”, explains Dr. Vázquez Guzmán, after indicating that there are vaginal surgeries that are done without laparoscopic cameras, abdominal surgeries that involve a wound and others in which the small laparoscopic holes are used.

Who benefits? Like everything in medicine, indicates that Dr. Vázquez Guzmán, everything has to be based on medical indications. But It is a good option for patients who have vaginal bleeding, those who have problems with the fallopian tubes or with the ovaries, especially cysts or fibroids. Can also be used in patients with pelvic prolapsewhich is when the muscles and ligaments of the pelvic floor weaken, so they no longer provide adequate support for the uterus.

However, there are some contraindications, warns Dr. Vázquez Guzmán. “This surgery is not for patients who have or are suspected of having a malignancy, such as ovarian, endometrial, fallopian tube, or cervical cancer. She is also not a candidate if she has surgery on the rectal system, such as a colostomy, as are those receiving radiation therapy to the pelvis and anyone with advanced endometriosis.”



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