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Minimally Invasive Options for Hysterectomy - VNOTES Hysterectomy

Dr. Brandon Lingenfelter will be discussing a new technology for hysterectomies called vNOTES and answering questions that patients may have about this groundbreaking procedure!
Minimally Invasive Options for Hysterectomy - VNOTES Hysterectomy
Featured Speaker:
Brandon Lingenfelter, DO, PhD
Problems in women’s health arise every day and it’s important to have a reliable doctor capable and ready to assist you. Fortunately, Dr. Brandon M. Lingenfelter offers expert care to women of all ages in Princeton, West Virginia, and the surrounding area. He attended the West Virginia School of Osteopathic Medicine in Lewisburg and received his doctorate in reproductive physiology from West Virginia University in Morgantown. He completed his residency in obstetrics and gynecology at Reading Health Systems in Philadelphia. Brandon M. Lingenfelter, DO, PhD, located in Princeton, West Virginia, is here to help make sure your health is never in question. Choosing the right health care provider can be a daunting decision for women. Not only must the physician be knowledgeable in their field of expertise, they must bring peace of mind at various stages of a woman’s life. Dr. Lingenfelter welcomes all patients and looks forward to becoming a lifelong partner in your long-term happiness and health. 

Learn more about Brandon Lingenfelter, DO, PhD

Bill Klaproth: Hysterectomy is the second most common surgery for women in the United States with approximately 500,000 hysterectomies performed yearly. So, let's talk about an advanced gynecological surgery option called vNOTES, which is a minimally invasive option for hysterectomy. And here to talk with us about this is Dr. Brandon Lingenfelter, founder of the Brandon M. Lingenfelter OB-GYN. He is also a board-certified OB-GYN and also certified in minimally invasive surgery.

This is the Top Docs Podcast. I'm your host, Bill Klaproth. Dr. Lingenfelter. Thank you so much for being here.

Dr. Brandon Lingenfelter: Hey, Bill, thanks for having me. I appreciate

Bill Klaproth: Yeah, you bet. This is a very common surgery, so I know a lot of women are interested in this. As I mentioned, hysterectomy is the second most common surgery for women in the United States behind cesarean section. So, what are some of the various ways that a hysterectomy can be done?

Dr. Brandon Lingenfelter: So traditionally, we would look at an abdominal hysterectomy where it was open came the advent of laparoscopic hysterectomy where you do it through three to four small holes in the belly. There's vaginal hysterectomy, and then those have been the mainstays of our therapy until we got into the newer procedures that we have now.

Bill Klaproth: Which I know is very beneficial to women because there is no scarring or marks, right, this minimally invasive surgery for patients. So, tell us about this now. We want to talk about the vNOTES hysterectomy. What is it? What do we need to know about it?

Dr. Brandon Lingenfelter: Yeah. So, vNOTES is really a vaginal hysterectomy. And ACOG is a big proponent of vaginal hysterectomies in general because it is a minimally invasive way to actually do the hysterectomy. Recovery times are still about the same, but your pain tends to be a little bit less.

So with the advent of this vaginal notes, which Dr. Baekelandt pioneered, is we actually are doing laparoscopic surgery through the vagina. And so, there's no scars as you've already mentioned, and the pain actually turns out that it's less. We've reduced the use of narcotics significantly where people are maybe using one or two pills versus the other procedures where they're using 10 to 20 pills afterwards. And in this given day and age, with the opioid pandemic and everything else that's going on, it really reduces the risk of there being excess opioids on the market plus it reduces the risk of actually getting somebody addicted to them.

Bill Klaproth: Absolutely. So, less pain, everybody's interested in that. That's certainly a big benefit, less medication. So certainly, there are benefits to the vNOTES procedure. What are some of the other benefits then to having a vNOTES hysterectomy compared to other methods?

Dr. Brandon Lingenfelter: Yeah. They're back on their feet a lot faster. They feel like they're getting a quicker recovery time, that they're actually having less downtime after surgery, there's less fatigue that's associated with it and they can feel like they're getting back onto their daily life a little bit faster. They still have the six-week restrictions and everything, but they still feel like they're more functional for their families and can actually do a little bit more along the way.

Bill Klaproth: So, less downtime, less fatigue. Again, those are big benefits. So, what is the recovery like then? How soon can the woman go home, resume normal activities? Give us the insight into that.

Dr. Brandon Lingenfelter: Yeah, that's a good question. So really, they're home the same day actually. There's really no stay in the hospital. Insurances do allow for a 23-hour stay on non-abdominal hysterectomy. But most of them are actually going home the same day. So typically, they're in the hospital from start to finish, maybe about eight hours or so. Then when they get home, they have cramping. It is not as significant as it had been in the past. They're typically taking ibuprofen. They're fatigued that day, tired. Typically within a week, they're back to maybe going back to work, having less cramping. Their pain is significantly reduced. They don't have the same type of upper abdominal pain that they would experience with the other types of hysterectomies. They tend to have a little bit less bleeding and just overall, they're back to walking more regularly. They still have to limit how much they lift, you know, at 15 to 20 pounds for the full six weeks. And their full recovery still is six weeks. And we still watch them for that long. But just they feel like they're normal and they can carry on their regular activities.

Bill Klaproth: So still a normal six-week recovery, but as you said, they go home the same day. Generally, they can go back to work within a week. There's less bleeding, less upper abdominal pain. So, these really are beneficial to women. I can understand how the vNOTES procedure is something that someone certainly would be interested in. This sounds like a really interesting and useful procedure. On what other procedures do you use the vNOTES device?

Dr. Brandon Lingenfelter: Yeah. So, we do tubal legations the same way. You can actually just make a small incision up underneath the cervix and you insert the device. It's a retractor that's a sleeve that allows us to take the tubes all the way out. We can also do ectopic pregnancies the same way, which actually reduces our operating time because typically we're seeing bleeding with ectopic pregnancies, unfortunately. And when we do it this way, we're evacuating the blood very quickly and we can see the tube right away and you actually get a better evacuation for the blood so that their pain actually afterwards is less because they don't have the blood that's such a bad irritant for the bowel hanging around. It's not causing irritation on the peritoneum or the lining of that abdomen. So, it really significantly increases it. And then, what we're also finding is that we're doing prolapse repairs at the same time that we're doing a hysterectomy where we're suspending the vagina back up because it's starting to fall down. So, we're fixing that at the same time and not having to make any other incisions on the belly.

Bill Klaproth: So minimally invasive surgery like this, not only good for hysterectomies, but for a variety of other conditions as well, which is really good news. Dr. Lingenfelter, as we wrap up, anything else you'd like to add?

Dr. Brandon Lingenfelter: Yeah. This is a really great procedure. There's about 800 surgeons in the United States that are actually trained to do this. And there's thousands of OB-GYNs, so it's a small percentage. It's not really clear how many are actually doing the procedure after the training. It is a certification that you have to go and get after everything is done just to ensure that you're doing it correctly and that you're actually following some good standards that are physician-led, that are surgeon-led. It really does improve the outcomes, and I'll be honest I've been incredibly impressed by the recoveries that patients have had, and they're incredibly happy with it. They're actively seeking that out, and I think it's great. It's just the next evolution to help with recovery and try to reduce our dependence on pain medicines postoperatively as well.

Bill Klaproth: Yeah. Those are all very, very good things, and it's podcasts like this that will help build awareness for the vNOTES procedure, which you have mentioned. Certainly does have many, many benefits to it. And as you said, the big one, improving outcomes, which is really what we want. Dr. Lingenfelter, if someone wants to learn more or book an appointment with you, what should they do?

Dr. Brandon Lingenfelter: Yeah. You can go to our website. It's We also have a Facebook page, or you can find us on Google. If you're looking for the vNOTES procedure in and of itself, you can actually go to YouTube and actually see a vNOTES procedure completed. And they actually walk through what's going on there. But we have more information on our website as well.

Bill Klaproth: Well, that sounds great. Dr. Lingenfelter, thank you so much for your time. We appreciate it.

Dr. Brandon Lingenfelter: Yes, thanks for having me today, Phil. I really like what you guys are doing with this Top Docs podcast.

Bill Klaproth: Yeah. Well, thank you so much. We do too. It's really becoming a thing and very useful to patients as well to learn about all of these great new procedures like the vNOTES procedure as well. So, thank you for your time. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. As Dr. Lingenfelter just said, this is the Top Docs Podcast. I'm Bill Klaproth. Thanks for listening.