KK Women's and Children's Hospital (KKH) has launched a new minimally invasive surgical technique for gynaecological surgeries including hysterectomies, which leaves no visible scars and allows patients to be discharged within a day.

A hysterectomy is one of the most common types of gynaecological surgeries performed in the world, and involves the surgical removal of the womb and cervix, with or without the fallopian tubes, or  ovaries. KKH performs 1,000 hysterectomies a year, with about half of these cases due to precancer or cancer.

The novel minimally invasive surgical technique is called vNOTES (vaginal natural orifice transluminal endoscopic surgery). It involves making a small cut in the vagina to create an opening for laparoscopic instruments to be inserted. Tissue is then burnt and cut to allow reproductive organs to be removed through the same opening. Finally, the incision is closed with dissolvable stitches.

This technique can only be performed by experienced and highly skilled surgeons, who have expertise in both urogynaecology and minimally invasive surgical techniques. KKH is one of the few leading healthcare institutions in the world and is the main centre in Singapore that offers this surgery.

In comparison to more conventional methods like open abdominal hysterectomies or laparoscopic (keyhole) hysterectomies, some benefits of vNOTES include leaving no visible scars, less pain, minimal blood loss and a faster recovery process.

Compared to conventional laparoscopy, vNOTES brings about advantages for women with a larger uterus, higher body mass index, or a history of umbilical hernia repair and other upper abdominal surgeries, shared Dr Kazila Bhutia, Consultant, Department of Urogynaecology, KKH.

One patient who has benefitted from vNOTES is Mdm Ejin Ang, who underwent the procedure in May 2023, following the discovery of a fibroid in her womb. After being offered several treatment options, she decided to undergo vNOTES. After the surgery, Mdm Ang was able to eat and walk within a few hours, and was discharged from KKH the following morning. She recovered well without the need for painkillers within a few days post-surgery.

Another patient, Ms Liu Kui, chose to undergo preventative surgery to reduce her lifetime risk of developing ovarian cancer upon testing positive for Breast Cancer gene 1 (BRCA 1). BRCA gene carriers have a higher risk of developing ovarian and breast cancers in the future. She was found to be a suitable candidate for vNOTES and also underwent the procedure in May 2023. Ms Liu was discharged on the same day of the procedure and experienced a quick recovery.

Including Mdm Ang and Ms Liu, more than 250 patients have benefitted from this procedure since its implementation in 2021.The cutting-edge procedure is expected to potentially benefit more than 400 patients a year.

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