Scarless Surgery/NOTES

Transvaginal Surgery 
The procedure, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), involves passing surgical instruments and a tiny camera through a natural orifice, such as the stomach or the vagina, to perform surgery. By avoiding major incisions through the skin, muscle, and nerves of the abdomen, patients recover more quickly, experience less pain and have no visible scars on their abdomen while the risk of post-operative complications such as wound infections and hernias is significantly reduced. 

A transvaginal cholecystectomy and appendectomy is a form of NOTES Scarless Surgery or Natural Orifice Translumenal Endoscopic Surgery (NOTES) surgery. NOTES surgery avoids any major incisions through the skin, muscle, or nerves by passing a surgical instrument and a tiny camera through a natural orifice, or body opening, such as the stomach or vagina. The results of this less-invasive surgery include a quicker recovery time, less pain, and no visible scars. In addition, the risk of wound infection is significantly reduced, while the risk for a surgically related hernia is completely eliminated. 

Yale gastrointestinal surgeon, Kurt Roberts, MD., is one of the pioneers who developed scarless surgery in the United States and around the world. In August of 2008, Dr. Roberts was the first to perform a transvaginal appendectomy (NOTES), requiring absolutely no abdominal incisions. His patient needed only one Tylenol to reduce discomfort, and she resumed normal activities in just two days. 

Since 2008, Dr. Roberts has performed several transvaginal appendectomies (NOTES) and has extended this new technique to the removal of gallbladders. The first transvaginal gallbladder surgery (NOTES) took less than an hour and a half and the female patient went home three hours later. She was able to recover quickly, with minimal postoperative pain and no visible scares. A laparoscopic gallbladder removal usually requires four incisions through the abdominal muscles, while in a transvaginal gallbladder removal (NOTES), only one small incision in the vagina is needed. 

NOTES surgery is becoming increasingly popular because it is even less invasive than traditional laparoscopic surgery, which still requires multiple abdominal incisions. The incision for transvaginal cholecystectomies and appendectomies is very small; therefore, the female reproductive organs are bypassed with this type of surgery. Child bearing and intercourse are not affected. 

NOTES is also performed through other natural orifices, such as the stomach for patients with appendicitis or symptomatic gallbladder disease.

Kurt Roberts, MDoptional caption 
Kurt Roberts, MD, is a board-certified general surgeon who is fellowship-trained in minimally invasive surgery. He is one of the pioneers who developed scarless surgery in the United States and around the world. He successfully performed what is believed to be the first transvaginal appendectomy with no abdominal incision whatsoever in the United States where the patient's appendix was removed through a small incision in the vagina. Without incisions in the abdomen, there is no opportunity to develop surgery-related hernias or wound infections. Patients who undergo procedures such as these recover and resume most normal activities within just a few days. In fact, the first woman who underwent this procedure only took one Tylenol for pain control and resumed her normal activities within two days after surgery. Since the incision in the patient’s vagina is very small and the female reproductive organs, especially the uterus, are bypassed with this type of surgery, child bearing and sex life are not affected. 

Since his first transvaginal appendectomy in August 2008, Dr. Roberts has performed several transvaginal appendectomies and has extended this new technique to the removal of gallbladders. The first transvaginal gallbladder surgery took less than an hour-and-a-half and the female patient went home three hours later. She was able to recover quickly, with minimal post-operative pain and no visible scars. Most importantly, she was able to return to full activities very quickly with a far lower risk for a wound infection than might have resulted from traditional laparoscopic gallbladder removal, which usually requires four incisions through the abdominal muscles.