Team of doctors led by Dr.Suyash Naval have performed India’s first Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) of ovarian cystectomy and hysterectomy on 23rd March 2019 at Naval Multi Speciality Hospital, Jalgaon, Maharashtra. Team included Dr.Suyash Naval, Dr.Rucha Naval, Dr. Sudarshan Naval and Dr. Jayashree Rane.

A benign right ovarian cyst was removed from one patient and uterus was removed from another patient by this novel approach of vNOTES leaving no abdominal scars to the patients. This new approach is therefore cosmetically superior to traditional open and laparoscopic surgery. vNOTES surgery also has advantages of lesser pain postoperatively, faster recovery and less hospital stay. Also no abdominal wounds mean no wound complications like wound infection, bleeding and incisional hernia.

vNOTES hysterectomy has potential to make difficult vaginal hysterectomy easier and feasible by adding the advantages of increased space and vision of high definition endoscopy. At the same time, it retains all the advantages of classical vaginal hysterectomy most important being, no abdominal scar.

According to Dr. Suyash Naval, most of the benign gynaecological surgeries can be performed by vNOTES approach. HALON trial has demonstrated that vNOTES hysterectomy is not inferior to laparoscopic hysterectomy (anotherminimally invasive approach) and results in faster recovery with less postoperative pain. However, situations like severe pelvic adhesions, endometriosis, malignancy and active pelvic infections are currently considered as contraindications for vNOTES.

In gynaecological surgery, the era of 1980s and 1990s was of paradigm shift from open surgery to laparoscopic surgery that reduced the size of incision to very minimal. In laparoscopic surgery also there has been a shift from multiport surgery to single port surgery. This evolution happened to reduce the invasiveness of surgery, for reduction in surgical pain score and for better cosmetic result. Natural Orifice Transluminal Endoscopic Surgery (NOTES) era started in general surgery in 2000s when first NOTES appendectomy was reported from India and NOTES cholecystectomy was reported from France. In 2012 Dr.HsuanSu from Taiwan published first transvaginal NOTES hysterectomy in gynaecology followed by reports from Belgium and China. It has been speculated that time for another paradigm shift in gynaecology from laparoscopy to NOTES approach has begun. India is now amongst first few countries to advance in this field.