**Abstract**

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is an exciting new procedure that combines the best of laparoscopic and transvaginal surgery. The skills of a laparoscopic surgeon are applied to this approach which offers several advantages over traditional laparoscopy. First, the recovery of a vaginal procedure is shorter and less painful. Second, there is no abdominal incision which avoids potential for wound infection, herniation, pain and unsightly scarring. Third, the surgeon is seated with more comfortable ergonomics than traditional laparoscopy. Fourth, the blood supply is controlled very early in the procedure reducing overall blood loss. Fifth, the specimen for removal is quite close to the operator which enables less crossing of instruments and allows larger scopes with better illumination to be used. Finally, where traditional laparoscopy progresses to a smaller and smaller surgical area as the operation proceeds deeper into the pelvis, vNOTES is continually moving out of the pelvis with greater room for specimen manipulation and visualization. Advantages over traditional transvaginal surgery include the ability to examine the entire abdomen, the safety of direct visualization of the pedicles for adnexal removal, and the ability to perform abdominal procedures including lymph node removal, omentectomy, appendectomy, and biopsies not previously available to the vaginal approach.

**Keywords:** vNOTES, minimally invasive surgery
