Scar-Free Laparoscopic Surgery for Gynecological Conditions

Tam Anh HCMC General Hospital iwill soon introduce vaginal laparoscopic surgery (V-NOTES) to treat gynecological conditions. With many advantages such as less pain, faster recovery, no visible scars, less need for painkillers, and lower risk of infection, V-NOTES is seen as a “revolution” in Obstetrics and Gynecology because it not only improves treatment outcomes but also meets the need for better aesthetic results.

This information was shared by experts at the seminar “Vaginal Laparoscopic Surgery (V-NOTES) in Gynecology” held on March 7, 2025, at the Tam Anh Research Institute (TAMRI). The seminar was organized by the Center for Obstetrics and Gynecology at Tam Anh General Hospital in collaboration with TAMRI. It attracted nearly 100 doctors and specialists in Obstetrics and Gynecology, Urogynecology, Urology, and Gynecologic Oncology from across the country, who came to learn about vaginal laparoscopic surgery from leading experts from the United States through a live surgical demonstration.

Ms. Hanh (51 years old, name has been changed) had gone through menopause one year ago and was found to have a large tumor in her left ovary during a medical examination. The tumor measured 9×10 cm. A CT scan revealed that the mass had a heterogeneous density, with areas of calcification and fat inside, and relatively well-defined borders. She was diagnosed with a benign ovarian dermoid cyst and was advised by her doctor to undergo vaginal laparoscopic surgery to remove the affected ovary.

The surgery was performed by Dr. Nguyen Ba My Nhi, MD, Level II Specialist and Director of the Center for Obstetrics and Gynecology at Tam Anh General Hospital in Ho Chi Minh City, with the support of Professor Nguyen Quoc Truong Chinh, MD, Director of the Department of Minimally Invasive Gynecologic Surgery at the Center for Obstetrics and Gynecology, University of Texas Medical Branch at Galveston. The entire procedure was broadcast live from the operating room at Tam Anh General Hospital in Ho Chi Minh City to the seminar hall.

The vaginal laparoscopic surgery to remove the ovary with a tumor in the 51-year-old patient was broadcast live from the operating room to the seminar hall

Dr. Nguyen Ba My Nhi, MD, Level II Specialist, shared that this was the first vaginal laparoscopic surgery to remove a large ovarian tumor performed at Tam Anh General Hospital in Ho Chi Minh City. The patient was placed under general anesthesia, and the vaginal and perineal areas were thoroughly disinfected multiple times. The surgical team then inserted a vaginal speculum and used a specially designed instrument set for vaginal laparoscopic surgery to remove the left ovary containing the large tumor, which was extracted through the vaginal opening.

Prof. Nguyen Quoc Truong Chinh, MD, explained that in recent decades, minimally invasive surgical techniques have advanced significantly, with vaginal laparoscopic surgery emerging as a cutting-edge method that combines laparoscopy with vaginal surgery. Specialized instruments designed specifically for this procedure are inserted through the vagina into the pelvic cavity, allowing surgeons to access the uterus, fallopian tubes, and ovaries without making any abdominal incisions, as was required in traditional laparoscopic surgery.

Having performed nearly 150 vaginal laparoscopic surgeries over the past 4 years, Prof. Nguyen Quoc Truong Chinh, MD, noted that this method offers patients numerous benefits, including less pain, faster recovery, no visible scarring, reduced need for pain medication, and a lower risk of infection. In the United States, this technique is well received by patients because it saves time, lowers treatment costs, and, most importantly, delivers better aesthetic outcomes.

Prof. Nguyen Quoc Truong Chinh, MD, Director of the Department of Minimally Invasive Gynecologic Surgery at the Center for Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, presenting the V-NOTES technique

According to Dr. Do Huu Trieu, Clinical Instructor and Research Fellow in the Department of Urogynecology and Pelvic Reconstructive Surgery at the Center for Obstetrics and Gynecology, University of Texas, medical literature worldwide recognizes V-NOTES as a minimally invasive surgical technique that has the potential to replace conventional laparoscopy. In Southeast Asia, Singapore has already adopted this technique, and in the future, more physicians in other countries are expected to learn and implement it.

From a medical standpoint, V-NOTES is particularly effective and safe for women who are overweight or have an enlarged uterus. Moreover, in cases involving large gynecologic tumors, removing the mass through abdominal laparoscopy can be challenging, while the vaginal muscles are more flexible and better suited for extracting larger tissue specimens with greater ease.

Dr. Do Huu Trieu, Clinical Instructor and Research Fellow in the Department of Urogynecology and Pelvic Reconstructive Surgery at the Center for Obstetrics and Gynecology, University of Texas, expects that V-NOTES will soon replace conventional laparoscopic surgery

Prof. Nguyen Quoc Truong Chinh, MD, also noted that, like all gynecologic surgical methods, V-NOTES carries certain risks of complications. This technique can potentially cause injury to nearby organs such as the bladder and rectum – similar to traditional laparoscopic surgery. Therefore, surgeons performing this procedure must be highly skilled experts in minimally invasive surgery, with extensive experience in both laparoscopy and vaginal surgery. He remarked, “The doctors at Tam Anh HCMC General Hospital are all seasoned specialists in laparoscopic surgery and will undoubtedly be able to adopt this technique quickly”.

Currently, the V-NOTES technique is widely used around the world to treat various gynecologic conditions, including ovarian cyst removal, fibroid removal, hysterectomy, oophorectomy, ectopic pregnancy removal, and female sterilization.

Dr. Nguyen Ba My Nhi, MD, Level II Specialist, shared that in the past, treating large gynecologic tumors often required open surgery, with long incisions on the abdomen to remove the mass. More than 30 years ago, laparoscopic surgery began to be adopted, allowing for smaller abdominal incisions of only about 5–10 mm, resulting in less blood loss, reduced postoperative pain, shorter hospital stays, and faster recovery. Today, the medical field has further advanced to scar-hidden laparoscopic surgery, which is considered a modern surgical trend. Surgeons can now insert an endoscope through a natural opening (like the mouth, nose, urethra, vagina, or rectum) to reach the surgical site.

In gynecologic surgery, doctors insert laparoscopic instruments into the abdominal cavity through a small incision made in the vaginal wall, allowing the surgical scar to be completely hidden. This method conceals the incision, avoids abdominal trauma, and reduces the risk of incisional hernia. It also helps minimize the psychological stress associated with surgery, enabling faster recovery. Women who undergo vaginal laparoscopic surgery can resume normal sexual activity and still can conceive and give birth naturally.

Ms. Hanh was the first patient to undergo vaginal laparoscopic surgery instead of the conventional method, which typically leaves 3 to 4 scars on the abdomen. She was delighted to experience no pain after the surgery, recovered quickly, and was surprised to be fully treated without any visible surgical scars.

Dr. Nguyen Ba My Nhi, MD, Level II Specialist and Director of the Department of Obstetrics and Gynecology at Tam Anh HCMC General Hospital, stated that the hospital will soon adopt V-NOTES in the treatment of various gynecologic conditions, not only to improve treatment outcomes but also to ensure better aesthetic results for women

Vaginal laparoscopic surgery is considered a “revolution” in the field of obstetrics and gynecology, marking a new chapter in minimally invasive surgical techniques. In the past, this method was difficult to perform because inserting instruments through the vaginal opening was obstructed, making it hard for surgeons to visualize the surgical area. Today, however, advanced equipment specifically designed for this technique allows for better vaginal access and provides specialized tools that make the procedure easier for surgeons to perform.

The seminar continued with an engaging discussion between nearly 100 physicians from hospitals across the country and the presenting experts. These direct exchanges provided an opportunity to update clinical knowledge, share practical experience, and enhance the effective application of vaginal laparoscopic surgery techniques.

Physicians from various hospitals across the country engaged in lively discussions with the presenters, exchanging knowledge and practical experience on the application of V-NOTES in gynecologic treatment

After undergoing training and learning the technique from international professors, the Department of Obstetrics and Gynecology at Tam Anh HCMC General Hospital is preparing to implement this advanced surgical method. The Center consistently updates its practices with the latest medical advancements and treatment protocols to continuously improve the quality of care and reinforce its leading position in this field in Vietnam.