03/30/2026
Literature Spotlight: vNOTES and the Future of Vaginal Surgery
A recent review by Veronica Lerner, Amanda Ulrich, Chi Chiung Grace Chen, and Jan Baekelandt titled “Vaginal Natural Or***ce Transluminal Endoscopic Surgery in Minimally Invasive Gynecologic Surgery”, published in Obstetrics & Gynecology (April 2026), provides a comprehensive review of the current state and evolving role of vNOTES in gynecologic surgery.
Despite longstanding recommendations favoring the vaginal route for benign hysterectomy due to lower morbidity, reduced cost, and faster recovery, vaginal hysterectomy rates in the United States have declined significantly over the past two decades and are projected to fall even further.
The authors highlight that this decline is multifactorial, with a major contributor being the widespread adoption of laparoscopic and robotic approaches, which offer improved visualization and perceived technical control. However, these approaches often come at the expense of increased invasiveness compared with the vaginal route.
vNOTES has emerged as a technique that integrates the advantages of both approaches—leveraging transvaginal access while incorporating laparoscopic visualization and instrumentation. Across multiple studies and systematic reviews, vNOTES is associated with:
• Shorter operative times
• Reduced blood loss
• Lower postoperative pain
• Shorter hospital stays
• Comparable or reduced complication rates
Importantly, implementation studies demonstrate that adoption of vNOTES can significantly shift surgical practice patterns, with one series showing an increase in vaginal approach rates from 40.1% to 94.3%, alongside marked reductions in abdominal and laparoscopic approaches.
The authors conclude that vNOTES represents a potential pathway to re-establish the vaginal route as a primary surgical approach, while maintaining the visualization and versatility that have driven the adoption of minimally invasive transabdominal techniques.
This is exactly the type of discussion TUUGS was built for.
Where is pelvic surgery going?
Are we moving forward—or drifting away from what we already know works best for patients?
At this year’s TUUGS Scientific Meeting, these are not theoretical conversations—they are practical, immediately applicable surgical discussions with colleagues who are actively doing this work.
You will hear from surgeons who are:
• Actively incorporating advanced vaginal and hybrid techniques
• Challenging the default to abdominal approaches
• Sharing real-world outcomes—not just published data
• Providing surgical insights you can take directly into the OR the following week
This is not a passive meeting.
This is a working meeting for surgeons who want to refine how they operate.
TUUGS Scientific Meeting
May 1–2, 2026
Galveston, Texas
Registration is open.
Bring your partners. Bring your partners’ partners.
If you care about the direction of pelvic surgery—
you should be in the room.
Illustrations created by Bernard L. Cook, PhD.
