Minimally Invasive Surgery & vNOTES

Modern gynaecological surgery prioritises minimal tissue disruption for faster recovery, less pain, and better cosmetic outcomes. Dr. Maazouzi is trained in the full spectrum of minimally invasive techniques, including the innovative vNOTES approach.

The philosophy of minimally invasive surgery

Minimally invasive surgery (MIS) refers to surgical techniques that achieve the same objectives as traditional open surgery but through smaller incisions or natural body openings. The principle is simple: less trauma to the body means faster healing, less postoperative pain, shorter hospital stays, and earlier return to daily activities.

In gynaecology, minimally invasive approaches are now the standard of care for the vast majority of procedures, from simple cyst removal to complex cancer surgery. Dr. Maazouzi is committed to offering patients the least invasive option appropriate for their condition.

Laparoscopy

Laparoscopy (keyhole surgery) is the most widely used minimally invasive technique in gynaecology. The surgeon operates through 3–4 small incisions (5–10 mm) in the abdomen, using a camera and specialised instruments.

  • Advantages — reduced postoperative pain, smaller scars, lower risk of wound complications, shorter hospital stay (often day-case or 1 night), and faster return to work and exercise
  • Common indications — ovarian cyst removal, treatment of endometriosis, myomectomy (fibroid removal), salpingectomy, hysterectomy, prolapse repair (sacrocolpopexy), and staging of gynaecological cancers
  • Enhanced visualisation — the laparoscopic camera provides magnified, high-definition views of the pelvis, allowing greater precision than the naked eye during open surgery
Recovery: Most patients can return home on the same day or the day after surgery. Light activities can typically be resumed within a few days, with full recovery in 2–4 weeks depending on the procedure.

Hysteroscopy

Hysteroscopy allows direct visualisation and treatment of conditions inside the uterine cavity, using a thin telescope inserted through the cervix. No abdominal incision is required.

  • Diagnostic hysteroscopy — performed as an outpatient procedure (often without general anaesthesia) to investigate abnormal bleeding, recurrent miscarriage, or suspected intrauterine abnormalities
  • Operative hysteroscopy — used to remove endometrial polyps, submucosal fibroids, intrauterine adhesions (Asherman syndrome), or uterine septa. Also used for endometrial ablation in selected cases of heavy menstrual bleeding
  • Advantages — no incisions, rapid recovery, usually performed as a day-case procedure, and minimal disruption to daily life

vNOTES: vaginal natural orifice transluminal endoscopic surgery

vNOTES represents the latest evolution in minimally invasive gynaecological surgery. It combines the benefits of laparoscopy with the advantages of the vaginal route, resulting in a truly scarless procedure.

  • How it works — a small port is placed through the vagina (a natural opening), and the surgical instruments and camera are introduced through this access point. The surgeon operates with the same precision as conventional laparoscopy, but without any abdominal incision
  • No visible scars — since the only access point is the vagina, there are no external scars on the abdomen whatsoever
  • Reduced pain — studies show less postoperative pain compared with conventional laparoscopy, likely because no incisions pass through the abdominal wall muscles
  • Faster recovery — many patients experience an even quicker return to normal activities compared with standard laparoscopy
Evidence-based innovation: vNOTES has been validated by a growing body of international clinical research demonstrating equivalent safety and efficacy to conventional laparoscopy, with the added benefits of reduced pain and superior cosmetic outcomes.

Indications for vNOTES

The vNOTES technique can be used for a wide range of gynaecological procedures:

  • Hysterectomy — total removal of the uterus, with or without the ovaries and fallopian tubes
  • Bilateral salpingectomy — removal of the fallopian tubes (for sterilisation or risk reduction)
  • Salpingo-oophorectomy — removal of the ovary and fallopian tube (for benign ovarian pathology)
  • Ovarian cystectomy — removal of ovarian cysts while preserving the ovary
  • Treatment of endometriosis — excision of endometriotic lesions and adhesions
  • Myomectomy — removal of certain fibroids

Suitability for vNOTES depends on individual anatomy, the nature of the condition, previous surgical history, and the size of any pathology. During the preoperative consultation, Dr. Maazouzi will assess whether vNOTES is the optimal approach for your specific case.

Preparing for surgery

Whatever the surgical approach, careful preparation ensures the best possible outcome:

  • Preoperative consultation — thorough discussion of the procedure, expected outcomes, potential risks, and recovery timeline. All questions are encouraged
  • Anaesthetic assessment — meeting with the anaesthetist to review your medical history and plan the most appropriate anaesthesia
  • Practical instructions — guidance on fasting, medications, and what to bring on the day of surgery
  • Postoperative support — clear instructions for recovery at home, pain management, wound care (if applicable), and scheduled follow-up
Dr. Maazouzi’s commitment: The choice of surgical technique is always guided by what is safest and most beneficial for the patient. When multiple approaches are possible, the least invasive option is preferred, and the decision is made together with the patient after transparent discussion of the options.

Book an Appointment

Discuss your specific situation with Dr. Maazouzi.

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