Transvaginal Hysterectomy (NOTES technique): A Path to Renewed Wellbeing at WIH Hospital

At WIH Hospital, we understand that the decision to undergo a hysterectomy is significant. It marks the end of chronic pain and discomfort, and it is a vital step in the gender affirmation journey. Our commitment is to provide the most advanced, minimally invasive techniques. A Transvaginal Hysterectomy (NOTES Technique), a procedure with no external incisions, offers a recovery that is not only faster but also gentler on the body.

What is Transvaginal Hysterectomy?

A Transvaginal Hysterectomy is a surgical procedure to remove the uterus through a small incision made in the vagina. Unlike an abdominal hysterectomy, which requires an external incision on the abdomen, this technique leaves no visible scars. Depending on the patient’s specific medical needs, the surgeon may also remove the cervix (total hysterectomy), and in some cases, the fallopian tubes (salpingectomy) and ovaries (oophorectomy).

During the procedure, the surgeon accesses the uterus through an incision made inside the vagina. Specialized instruments are then used to carefully detach the uterus from its surrounding ligaments and blood vessels. Once detached, the uterus is removed through the vaginal opening. In some cases, the fallopian tubes and ovaries may also be removed via the same vaginal incision if clinically indicated.

The innovation of the NOTES Technique?

The Natural Orifice Transluminal Endoscopic Surgery (NOTES) technique elevates the standard transvaginal hysterectomy to a more advanced level. In a NOTES procedure, a specialized endoscopic camera and instruments are passed through the vagina. This allows the surgeon to have a high-definition view of the pelvic organs. The uterus is carefully detached and removed through the vagina, leaving no visible scars on the abdomen. This “scarless” approach is a significant, minimally invasive gynecological surgery.

Who May Need a Transvaginal Hysterectomy (NOTES Technique)?

  • Uterine Fibroids: Benign tumors that cause heavy menstrual bleeding, pelvic pain, and pressure.
  • Endometriosis: A condition where the tissue that normally lines the uterus grows outside of it, causing significant pain.
  • Adenomyosis: A condition where the uterine lining grows into the muscular wall of the uterus.
  • Uterine Prolapse: When the uterus descends into the vaginal canal due to weakened pelvic floor muscles.
  • Abnormal Uterine Bleeding: Persistent, heavy, or irregular bleeding that does not respond to other treatments.
  • Chronic Pelvic Pain: When the source of the pain is determined to be the uterus.
  • Gynecologic Cancer: Cancer of the uterus, cervix, or ovaries.
  • Gender Affirmation: For female-to-male (FTM) individuals, a hysterectomy is a key component of the gender-affirming journey.

The Importance of Transvaginal Hysterectomy (NOTES) in FTM Gender-Affirming Care

For many transgender men (FTM) and gender non-conforming individuals, a hysterectomy is a crucial and affirming step in their transition. At WIH Hospital, we provide a safe, respectful, gender affirming environment and also minimally invasive Transvaginal Hysterectomy (NOTES technique) with the added advantage of no abdominal scarring, which can be particularly important for body image and a positive transitional experience.

Why is this procedure so important?

Alleviation of Gender Dysphoria: The presence of a uterus and the experience of menstruation can be significant sources of emotional distress and gender dysphoria. Removing the uterus can align one’s body with their gender identity.

Cessation of Menstruation: For individuals on testosterone therapy, breakthrough bleeding can still occur. A hysterectomy provides a definitive end to menstruation.

Preparation for Further Gender-Affirming Surgeries: A hysterectomy is often a precondition for genital reconstruction surgeries such as metoidioplasty or phalloplasty.

Eliminating the Risk of Uterine and Cervical Cancers: For individuals undergoing long-term testosterone therapy, a hysterectomy removes the risk of developing cancers in these organs.

What is Transvaginal Hysterectomy?

A Transvaginal Hysterectomy is a surgical procedure to remove the uterus through a small incision made in the vagina. Unlike an abdominal hysterectomy, which requires an external incision on the abdomen, this technique leaves no visible scars. Depending on the patient’s specific medical needs, the surgeon may also remove the cervix (total hysterectomy), and in some cases, the fallopian tubes (salpingectomy) and ovaries (oophorectomy).

During the procedure, the surgeon accesses the uterus through an incision made inside the vagina. Specialized instruments are then used to carefully detach the uterus from its surrounding ligaments and blood vessels. Once detached, the uterus is removed through the vaginal opening. In some cases, the fallopian tubes and ovaries may also be removed via the same vaginal incision if clinically indicated.

The innovation of the NOTES Technique?

The Natural Orifice Transluminal Endoscopic Surgery (NOTES) technique elevates the standard transvaginal hysterectomy to a more advanced level. In a NOTES procedure, a specialized endoscopic camera and instruments are passed through the vagina. This allows the surgeon to have a high-definition view of the pelvic organs. The uterus is carefully detached and removed through the vagina, leaving no visible scars on the abdomen. This “scarless” approach is a significant, minimally invasive gynecological surgery.

Who May Need a Transvaginal Hysterectomy (NOTES Technique)?

  • Uterine Fibroids: Benign tumors that cause heavy menstrual bleeding, pelvic pain, and pressure.
  • Endometriosis: A condition where the tissue that normally lines the uterus grows outside of it, causing significant pain.
  • Adenomyosis: A condition where the uterine lining grows into the muscular wall of the uterus.
  • Uterine Prolapse: When the uterus descends into the vaginal canal due to weakened pelvic floor muscles.
  • Abnormal Uterine Bleeding: Persistent, heavy, or irregular bleeding that does not respond to other treatments.
  • Chronic Pelvic Pain: When the source of the pain is determined to be the uterus.
  • Gynecologic Cancer: Cancer of the uterus, cervix, or ovaries.
  • Gender Affirmation: For female-to-male (FTM) individuals, a hysterectomy is a key component of the gender-affirming journey.

The Importance of Transvaginal Hysterectomy (NOTES) in FTM Gender-Affirming Care

For many transgender men (FTM) and gender non-conforming individuals, a hysterectomy is a crucial and affirming step in their transition. At WIH Hospital, we provide a safe, respectful, gender affirming environment and also minimally invasive Transvaginal Hysterectomy (NOTES technique) with the added advantage of no abdominal scarring, which can be particularly important for body image and a positive transitional experience.

Why is this procedure so important?

Alleviation of Gender Dysphoria: The presence of a uterus and the experience of menstruation can be significant sources of emotional distress and gender dysphoria. Removing the uterus can align one’s body with their gender identity.

Cessation of Menstruation: For individuals on testosterone therapy, breakthrough bleeding can still occur. A hysterectomy provides a definitive end to menstruation.

Preparation for Further Gender-Affirming Surgeries: A hysterectomy is often a precondition for genital reconstruction surgeries such as metoidioplasty or phalloplasty.

Eliminating the Risk of Uterine and Cervical Cancers: For individuals undergoing long-term testosterone therapy, a hysterectomy removes the risk of developing cancers in these organs.

What is Transvaginal Hysterectomy?

A Transvaginal Hysterectomy is a surgical procedure to remove the uterus through a small incision made in the vagina. Unlike an abdominal hysterectomy, which requires an external incision on the abdomen, this technique leaves no visible scars. Depending on the patient’s specific medical needs, the surgeon may also remove the cervix (total hysterectomy), and in some cases, the fallopian tubes (salpingectomy) and ovaries (oophorectomy).

During the procedure, the surgeon accesses the uterus through an incision made inside the vagina. Specialized instruments are then used to carefully detach the uterus from its surrounding ligaments and blood vessels. Once detached, the uterus is removed through the vaginal opening. In some cases, the fallopian tubes and ovaries may also be removed via the same vaginal incision if clinically indicated.

The innovation of the NOTES Technique?

The Natural Orifice Transluminal Endoscopic Surgery (NOTES) technique elevates the standard transvaginal hysterectomy to a more advanced level. In a NOTES procedure, a specialized endoscopic camera and instruments are passed through the vagina. This allows the surgeon to have a high-definition view of the pelvic organs. The uterus is carefully detached and removed through the vagina, leaving no visible scars on the abdomen. This “scarless” approach is a significant, minimally invasive gynecological surgery.

Who May Need a Transvaginal Hysterectomy (NOTES Technique)?

  • Uterine Fibroids: Benign tumors that cause heavy menstrual bleeding, pelvic pain, and pressure.
  • Endometriosis: A condition where the tissue that normally lines the uterus grows outside of it, causing significant pain.
  • Adenomyosis: A condition where the uterine lining grows into the muscular wall of the uterus.
  • Uterine Prolapse: When the uterus descends into the vaginal canal due to weakened pelvic floor muscles.
  • Abnormal Uterine Bleeding: Persistent, heavy, or irregular bleeding that does not respond to other treatments.
  • Chronic Pelvic Pain: When the source of the pain is determined to be the uterus.
  • Gynecologic Cancer: Cancer of the uterus, cervix, or ovaries.
  • Gender Affirmation: For female-to-male (FTM) individuals, a hysterectomy is a key component of the gender-affirming journey.

The Importance of Transvaginal Hysterectomy (NOTES) in FTM Gender-Affirming Care

For many transgender men (FTM) and gender non-conforming individuals, a hysterectomy is a crucial and affirming step in their transition. At WIH Hospital, we provide a safe, respectful, gender affirming environment and also minimally invasive Transvaginal Hysterectomy (NOTES technique) with the added advantage of no abdominal scarring, which can be particularly important for body image and a positive transitional experience.

Why is this procedure so important?

Alleviation of Gender Dysphoria: The presence of a uterus and the experience of menstruation can be significant sources of emotional distress and gender dysphoria. Removing the uterus can align one’s body with their gender identity.

Cessation of Menstruation: For individuals on testosterone therapy, breakthrough bleeding can still occur. A hysterectomy provides a definitive end to menstruation.

Preparation for Further Gender-Affirming Surgeries: A hysterectomy is often a precondition for genital reconstruction surgeries such as metoidioplasty or phalloplasty.

Eliminating the Risk of Uterine and Cervical Cancers: For individuals undergoing long-term testosterone therapy, a hysterectomy removes the risk of developing cancers in these organs.

Types of Transvaginal Hysterectomy (NOTES Technique)

  • Total Transvaginal Hysterectomy: The most common type, where the entire uterus and cervix are removed.
  • Transvaginal Hysterectomy with Bilateral Salpingo-Oophorectomy: In addition to the uterus and cervix, both fallopian tubes and ovaries are removed. This is often recommended to reduce the risk of ovarian cancer or if there are abnormalities in the ovaries.
  • Transvaginal Hysterectomy with Salpingectomy: The uterus, cervix, and fallopian tubes are removed, while the ovaries are left in place to continue producing hormones.

Step-By-Step Procedure for Transvaginal Hysterectomy

  • Anesthesia: The surgery will be performed under general anesthesia or intravenous sedation.
  • Access: The surgeon will gently insert a speculum into the vagina to have a clear view of the cervix.
  • Incision: A small internal incision is carefully made around the cervix within the vagina.
  • Detachment: The surgeon will detach the uterus from the surrounding ligaments, blood vessels, and fallopian tubes.
  • Removal: The uterus is then carefully removed through the vagina.
  • Closure: The small internal incision at the top of the vagina is closed with dissolvable sutures.

Why is Transvaginal Hysterectomy Performed?

Transvaginal Hysterectomy is a treatment option for various gynecological conditions, particularly those that involve uterine descent or can be effectively managed without abdominal access. It is often recommended for conditions such as:

  • Uterine Prolapse: This is a primary indication for TVH, as the uterus has already descended into the vaginal canal. The surgery can also address associated pelvic floor weakness.
  • Abnormal Uterine Bleeding: Persistent or heavy bleeding not controlled by other treatments.
  • Fibroids (smaller size): Non-cancerous growths in the uterus, especially if the uterus is not excessively enlarged.
  • Chronic Pelvic Pain: When the uterus is identified as the source and other treatments have failed.
  • Endometrial Hyperplasia: Thickening of the uterine lining that can be pre-cancerous.

It’s important to note that TVH may not be suitable for all conditions, particularly very large fibroids, severe endometriosis, or suspected gynecological cancers that require extensive examination of the abdominal cavity.

Pre-operative and post-operative Care

Pre-operative Care

  • Our team will provide instructions on which medications to stop or continue.
  • Follow all fasting instructions.
  • Stop smoking 1-2 weeks before the surgery.

Post-operative Care

  • Our experienced nurses will monitor the patient in the recovery room.
  • The surgeon will prescribe medication for pain and discomfort.
  • Attend all follow-ups at the WIH hospital with the surgeon.

The Role of Ultrasound Detection After Transvaginal Hysterectomy

  • Evaluate the Ovaries: If the ovaries were not removed, an ultrasound can be used to monitor them for any abnormalities.
  • Assess the Vaginal Cuff: This is the area at the top of the vagina where the cervix was removed. An ultrasound can help to ensure it is healing properly.
  • Investigate Any Post-Operative Symptoms: If the patient experiences any unusual pelvic pain or other symptoms, an ultrasound can be a useful diagnostic tool.

Recovery Timeline

  • Week 1: The initial focus is on rest, and patients will be encouraged to take short walks.
  • Weeks 2-3: The patient can move more comfortably and engage in light activities. Avoid heavy lifting and strenuous exercise. Some vaginal discharge or spotting is normal during this time.
  • Weeks 4-6: The patient can return to work, depending on the nature of the job, and can increase the activity levels.
  • After 6 Weeks: Most patients can resume all normal activities, including sexual intercourse. The internal tissues will continue to heal for several more months.

Limitations of Transvaginal Hysterectomy

  • A very large uterus: It may be difficult to remove a significantly enlarged uterus through the vagina.
  • Previous abdominal surgeries: Extensive scar tissue from earlier operations can complicate the procedure.
  • Suspected or Confirmed Gynecological Cancer: In certain cases, an abdominal approach may be necessary for a better assessment of the disease’s extent.

Benefits of Transvaginal Hysterectomy (NOTES Technique)

  • Improved Mental Health
  • Enhanced Quality of Life
  • No Abdominal Scarring
  • Cessation of Menstruation
  • Elimination of the Risk of Uterine and Cervical Cancer
  • Facilitation of Future Gender-Affirming Surgery

What to Expect During Your Transvaginal Hysterectomy Journey

At WIH International Hospital, we are dedicated to providing personalized and supportive care. Your journey with Transvaginal Hysterectomy will typically involve:

  1. Detailed Consultation and Evaluation: Our highly experienced gynecological surgeons will thoroughly assess your condition, medical history, and suitability for TVH. We will discuss all available options and ensure you understand the procedure fully.
  2. Pre-operative Instructions: You’ll receive clear guidance on how to prepare for your surgery, including dietary restrictions and medication adjustments.
  3. The Procedure: Performed under general or regional anesthesia, the surgery typically takes 1-2 hours.
  4. Post-operative Care: You will be closely monitored. Our team will provide pain management, monitor your recovery, and give instructions for managing discomfort and activity levels.
  5. Follow-up Appointments: Essential follow-up visits will be scheduled to monitor your healing and address any questions or concerns.

Why Choose WIH for the Transvaginal Hysterectomy (NOTES Technique)?

At WIH International Hospital, we combine world-class medical expertise with cutting-edge technology and compassionate care to ensure the best possible outcomes. Our gynecologic surgeons are highly specialized in minimally invasive techniques, including transvaginal hysterectomy, offering unparalleled precision and safety.

If you are experiencing gynecological symptoms and wish to explore Transvaginal Hysterectomy or other treatment options, we invite you to schedule a consultation with our specialists and gynecologists.

Frequently Asked Questions

You can expect some discomfort, but it is generally less than with an abdominal hysterectomy. We will provide you with effective pain management to keep you comfortable.

The main difference lies in the surgical access and scarring. Open hysterectomy uses a large abdominal incision. Laparoscopic hysterectomy uses several small abdominal incisions. Transvaginal Hysterectomy (TVH), however, uses an incision only inside the vagina, leaving no abdominal scars whatsoever. This often leads to less pain and a faster recovery compared to abdominal approaches.

Most individuals can return to a desk job within 2 to 4 weeks. If your job is physically demanding, you may need to wait up to 6 weeks.

If your ovaries are removed during the hysterectomy, you will enter menopause. If your ovaries are left in place, you will not go into menopause until it naturally occurs.

There are potential risks, including infection, bleeding, and injury to surrounding organs. However, these risks are minimized by the expertise of our surgical team and our adherence to strict safety protocols.

You’ll receive specific pre-operative instructions, which typically include fasting before surgery and adjusting certain medications (like blood thinners) as advised by your doctor. It’s also important to arrange for someone to drive you home after the procedure.

The best way to determine your candidacy is to schedule a consultation with one of our expert gynecological surgeons at WIH Hospital. They will perform a thorough evaluation and discuss all of your options with you.

WIH Hospital

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Ready to learn more, or need support with your dilation routine? Contact Dr. Chettasak’s team at WIH International Hospital.

WhatsApp: +66 95 650 3892
info@wihhospital.com