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MemorialCare Saddleback Medical Center performs Orange County’s first new minimally-invasive vNOTES surgery for hysterectomy patients

A new minimally invasive option for hysterectomy procedures is now available to Orange County patients. Known as vNOTES (vaginal natural orifice transluminal endoscopic surgery), the advanced gynecologic technique provides many benefits to female patients, such as a shorter hospital stay, less postoperative pain, no visible scars, and a faster recovery time.1

Daniel Sternfeld, MD, a board-certified OB/GYN at MemorialCare Medical Group in Laguna Hills, successfully performed Orange County’s first vNOTES at The Women’s Hospital at MemorialCare Saddleback Medical Center on Monday, December 13. Dr. Sternfeld was specially trained on this innovative approach to hysterectomy and other common gynecologic procedures.

“Our patients entrust us in the medical community to provide them access to today’s most innovative and clinically proven surgical techniques,” said Dr. Sternfeld. “As a less invasive option, vNOTES is both safe and efficacious in providing patients a quicker recovery time, less pain and no visible scarring.”

The vNOTES technique, which uses the vagina as a surgical access route, is the newest approach to hysterectomy procedures. During the surgery, a vNOTES device known as the GelPOINT® V-Path transvaginal access platform is placed through the vagina into the pelvic cavity, giving access to the uterus, fallopian tubes and ovaries. The vNOTES device is the means by which the abdomen is inflated with carbon dioxide gas to give the surgeon the space needed to see and operate. A high-definition camera and specialized instruments are inserted through the device, allowing surgeons to operate with the utmost precision and visualization. Once the surgery is completed, the vNOTES device is removed and the gas is evacuated.

“We are ecstatic that our first case was a success,” added Dr. Sternfeld. “The patient was in great spirits following the procedure, and she was released later that day and resting comfortably at home. This is an exciting day for MemorialCare Saddleback Medical Center and more importantly, for our patients throughout Orange County who now have another outstanding surgical option when deciding to undergo a hysterectomy.”

The HALON study, 2 [1] a randomized, controlled trial whose results were recently published in BJOG: An International Journal of Obstetrics and Gynaecology, showed that the vNOTES procedure has many advantages when compared to the traditional laparoscopic approach for hysterectomy. The duration of surgery was significantly shorter with vNOTES compared to laparoscopy, with an average of 41 minutes and 75 minutes, respectively. vNOTES was also associated with shorter hospital stay. Women in the vNOTES group stayed for an average of 0.8 days compared to 1.3 days in the laparoscopy group. Additionally, more women were treated as outpatients, with 77% of vNOTES patients choosing to return home same day, compared to 43% of laparoscopic patients. vNOTES patients self-reported lower pain scores and required less analgesics during the first 7 days following surgery, with an average of 8 units in the vNOTES group and 14 units in the laparoscopy group.

The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists have recommended vaginal hysterectomy, whenever feasible, as the approach of choice. 3,4 In the U.S., about 500,000 5,6 hysterectomies are performed each year for women with chronic pain, fibroids, heavy bleeding, endometriosis, and precancerous or cancerous tumors.

“MemorialCare takes tremendous pride in providing its patients access to the most advanced non-surgical and surgical treatment options,” explained Marcia Manker, CEO of MemorialCare Saddleback Medical Center. “The concept of ‘privademics,” or community hospitals participating in innovative clinical research trials to test new treatments, is now a reality thanks to our talented team of highly trained physicians and researchers. As a result, patients no longer have to only rely on academic hospitals to provide access to advanced care because innovation is now available right in their own backyard.”

“Surgical societies see the benefits of minimally invasive vaginal hysterectomy, but the procedure is rarely performed because of the difficulties involved in seeing and accessing critical anatomy. vNOTES solves these challenges through the use of innovative technology designed to enhance patient outcomes and we are grateful to be the first in Orange County to offer our patients access to it,” Dr. Sternfeld.

For more information about The Women’s Hospital at MemorialCare Saddleback Medical Center, please visit memorialcare.org/WomensCare.

This article was released by the memorialcare.org/.

[1] Baekelandt, J. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG. 2019 Jan;126(1):105-113
3 Choosing the route of hysterectomy for benign disease. Committee Opinion No.701. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017:129:e155-9
4 AAGL Position Statement: Route of Hysterectomy to Treat Benign Uterine Disease. JMIG 2011 Jan;18(1):P1-3
5 Einarsson J. Are hysterectomy volumes in the US really falling? Contemporary OB/GYN website. Sept 1, 2017. Accessed July 9, 2020. https://www.contemporaryobgyn.net/view/are-hysterectomy-volumes-us-really-falling
6 Cohen SL, Ajao MO, Clark NV, Vitonis AF, Einarsson JI. Outpatient hysterectomy volume in the United
States. Obstet Gynecol. 2017;130:130-7.