Photo By Michelle Stewart | Air Force Capt. Kristina Karlson, medical director, Women’s Health Clinic, Keesler...... read more read more
Keesler Medical Center has taken a significant step forward in gynecologic surgery with the introduction of Vaginal Natural Orifice Transluminal Endoscopic Surgery, or vNOTES.
This innovative procedure, led by Capt. Kristina L. M. Karlson, director of the Women's Health Clinic and Labor & Delivery at Keesler Medical Center, Biloxi, Miss., offers a minimally invasive alternative to traditional surgical methods, promising faster recovery times and reduced postoperative pain for patients.
Karlson was inspired to bring this innovative procedure to the medical center due to her passion for minimally invasive gynecologic surgery. Her training at Walter Reed National Military Medical Center, under the mentorship of Dr. Candice Jones-Cox, equipped her with the skills and knowledge to challenge traditional methods and provide patients with the best possible outcomes.
"vNOTES is a new type of surgery that lets doctors operate on parts like the tubes and ovaries, or remove the uterus and cervix, without making any cuts on the abdomen," Karlson said. "It can also help fix problems where organs in the pelvis drop out of place."
Traditional surgeries usually involve:
• Abdominal surgery involves cutting on the abdomen.
• Laparoscopic surgery involves making several small incisions and using a camera and specialized tools, sometimes with the assistance of a robot.
• Vaginal surgery involves operating through the vagina.
vNOTES is special because it combines the laparoscopic and vaginal methods, Karlson noted. Doctors use a camera and tools through the vagina to perform the surgery, avoiding cuts on the abdomen.
In residency, Karlson was taught to "go vaginally" whenever possible, as it is typically the most minimally invasive approach, leading to faster recovery, improved patient satisfaction, and fewer complications. One challenge with traditional transvaginal hysterectomy is the removal of the fallopian tubes and ovaries, which can be challenging to visualize.
"vNOTES allows for complete removal of these structures, reducing the future risk of ovarian cancer by 65 percent. It is the perfect blend of minimally invasive techniques," Karlson said.
Successful Implementation
Karlson has completed eight procedures so far and has an additional four scheduled for this summer. The estimated learning curve is around five procedures, with expansion into more complex cases around 30.
Introducing vNOTES at Keesler was not without its challenges.
The concept of "laparoscopy through the vagina" initially raised eyebrows among the operating room team. To address this, Karlson arranged for the vendor team to provide hands-on education sessions for surgical technicians and nurses, generating excitement and understanding. Consistency in the surgical team and vendor support during procedures also contributed to the successful implementation.
Performing the first vNOTES hysterectomy at Keesler on April 23, 2025, was a milestone for Karlson and her patient. The procedure not only resolved the patient's medical issues but also facilitated a faster and less painful recovery. This success has encouraged Karlson's colleagues to consider offering this approach to their patients as well.
"The response to vNOTES has been overwhelmingly positive," Karlson said. "Non-gynecologic colleagues have shown curiosity and support, while patients have reported high satisfaction with limited to no narcotic use after surgery and quick recovery. The surgical teams have also taken a keen interest in fine-tuning the process to reduce costs and waste."
"After thinking about it, I was overall pleasantly surprised with this procedure," said Brittany Serrano, a 37-year-old patient with three vaginal deliveries. "I did a lot of research (that I probably shouldn't have done beforehand). I was seeking diverse perspectives and experiences on various topics. A lot said this was a really big surgery and a rough recovery with weeks of pain. I think I only had three days of very manageable pain after surgery, so I am very pleasantly surprised."
"Even doing all my research, most people had laparoscopic assistance through the abdomen, and it was hard to find experiences with a vaginal approach only. I think that's a huge help in recovery, especially for those with kids and an active lifestyle. It didn't tie me down for weeks on end. I am thankful for everything," Serrano said.
Key Benefits of vNOTES
VNOTES offers numerous benefits, including shorter operative time, faster recovery and discharge, and fewer postoperative complications and pain, particularly compared to laparoscopic hysterectomy. Cost analyses have shown that vNOTES is less expensive than robotic hysterectomy and laparoscopic approaches for procedures that focuses on the adnexal, primarily the ovaries and fallopian tubes.
Karlson aims to continue offering vNOTES to appropriate candidates and engage her colleagues to expand access to this approach. She is interested in expanding its use to lower complexity adnexal surgeries and pelvic organ prolapse support procedures. vNOTES is gaining traction in gynecology, and facilities with specialists trained in minimally invasive gynecologic surgeries. These surgeons are more likely to offer this procedure and train future military gynecologic surgeons.
Karlson plans to continue educating patients and staff about the benefits of vNOTES. With patients' permission, she will involve learners, including phase II students and other trainees, in the operating room.
"Since Dr. Karlson arrived at Keesler Medical Center in 2024, she has sought out innovative ways to operate, coupled with increasing patient satisfaction while reducing cost, which sets her apart from her peers. Offering vNOTES at Keesler is a significant step in Dr. Karlson's journey towards specializing in gynecologic surgery," said Maj. Michele McMahon, Women's Health flight commander. "It allows her to provide the best outcomes for her patients and fill a gap within the DHA for access to this specialized approach. The experience has shaped her approach to innovation in military healthcare, requiring creativity and a fresh perspective for each case."
| Date Taken: | 07.14.2025 |
| Date Posted: | 07.15.2025 14:54 |
| Story ID: | 542839 |
| Location: | BILOXI, MISSISSIPPI, US |
| Web Views: | 191 |
| Downloads: | 0 |
This work, Breaking Barriers Gynecologic Surgery: The Introduction of vNOTES at Keesler Medical Center, by Michelle Stewart, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
No keywords found.
