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Related Experiment Video

Updated: Sep 8, 2025

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vNOTES for Ovarian Drilling: A New Minimal Invasive Technique.

Margaux Jegaden1, Elodie Debras1, Anne-Gaëlle Pourcelot2

  • 1Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre (all authors); Faculty of Medicine, University Paris-Sud Saclay (Drs. Jegaden, Debras, Capmas, and Fernandez), Le Kremlin Bicêtre.

Journal of Minimally Invasive Gynecology
|June 13, 2022
PubMed
Summary

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a new, minimally invasive approach for ovarian drilling in women with polycystic ovary syndrome. This technique facilitates simultaneous fertility assessment and treatment, aiming to restore spontaneous ovulation with reduced patient impact.

Keywords:
AMHDrillingFertilityPolycystic ovary syndromeSurgery

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Area of Science:

  • Reproductive Medicine
  • Minimally Invasive Surgery
  • Gynecologic Surgery

Background:

  • Ovarian drilling is a second-line treatment for dysovulatory polycystic ovary syndrome (PCOS) unresponsive to first-line therapies.
  • Traditional methods include laparoscopy and transvaginal hydrolaparoscopy, with the latter facing availability issues.
  • The goal is to restore spontaneous ovulation by ablating 5-10% of the ovarian cortex.

Purpose of the Study:

  • To demonstrate a novel, minimally invasive surgical technique for ovarian drilling and fertility workup using transvaginal natural orifice transluminal endoscopic surgery (vNOTES).
  • To present the stepwise procedure and its potential benefits for patients with PCOS.

Main Methods:

  • The technique utilizes a vNOTES kit, a 5 mm hysteroscope, and a bipolar spring electrode.
  • Key steps involve hysteroscopy, posterior colpotomy, introduction of the vNOTES system, ovarian drilling (approx. 10 holes per ovary), pelvic cavity exploration, and tubal patency assessment.
  • Bipolar energy is recommended to minimize ovarian damage and adhesions.

Main Results:

  • The vNOTES approach allows for simultaneous ovarian drilling and comprehensive fertility evaluation, including tubal patency and uterine cavity assessment.
  • This minimally invasive technique avoids abdominal scarring and is well-tolerated by patients.
  • It is particularly advantageous for bariatric patients, offering improved pelvic access compared to traditional laparoscopy.

Conclusions:

  • vNOTES-assisted ovarian drilling is a promising, minimally invasive alternative for PCOS management, potentially increasing the accessibility and applicability of this treatment.
  • The technique facilitates efficient fertility workup and treatment, aiming for long-term restoration of spontaneous ovulation.
  • Further adoption of vNOTES can enhance patient outcomes and simplify the surgical procedure for ovarian drilling.