The landscape of gynecologic surgery has undergone a profound transformation over the past three decades. What began as large abdominal incisions evolved into conventional laparoscopy, significantly reducing surgical trauma and accelerating patient recovery. Today, we stand at the threshold of the next paradigm shift: vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) – an advancement that merges laparoscopy with vaginal surgery to eliminate abdominal incisions entirely and combines the advantages of both procedures.
vNOTES allows access to the pelvic and abdominal cavities through the vagina using a specialized endoscopic port. The result is a procedure that is very precise and scarless. vNOTES combines the best features of both transvaginal and laparoscopic surgery, permitting women to undergo gynecologic procedures with the shortest recovery, the least amount of pain, and the most favorable cosmesis.
International experience and early adoption
The international expansion of vNOTES has been shaped by experts in the field of minimally invasive gynecologic surgery who adopted the technique early and helped refine its clinical application. Among them is Dr. Wael Hosni, a German board-certified gynecologic surgeon recognized for his expertise in minimally invasive surgery. Dr. Hosni was one of the first three surgeons in Germany to introduce vNOTES in the country and implement it into routine gynecologic practice in 2021.
After relocating from Europe to the United Arab Emirates, he became one of the first gynecologic surgeons to perform vNOTES in the region in 2022, broadening the minimally invasive surgical options available to patients.
In addition to his clinical work, he has lectured extensively at international congresses and has trained surgeons across Europe and the Middle East in adopting the scarless vNOTES technique.
Introducing vNOTES in Egypt: A national initiative
In November 2025, the Egyptian Society for Minimally Invasive Surgery (MISSE) invited Dr. Wael Hosni to introduce vNOTES to Egypt — a country with a rapidly evolving minimally invasive gynecology landscape and one of the highest academic surgical training outputs in the region.
The introduction of vNOTES in Egypt followed a structured, multistage implementation strategy designed to ensure safe adoption:
- Educational Webinar
More than 160 surgeons and experts from Egypt and the region attended a live online webinar that presented the evidence, clinical indications, perioperative management, surgical steps and patient benefits of vNOTES. - Hands-On Workshop
A fully booked workshop provided practical training using specialized vNOTES simulators, with emphasis on instrument handling, anatomical orientation, and case selection. - First Live Transmitted vNOTES Surgery
The workshop concluded with the first vNOTES surgery in Egypt, performed live by Dr. Wael Hosni and transmitted to all workshop participants, demonstrating the surgical steps in real time.
This stepwise model of education, simulation-based training, mentorship and live surgeries demonstrated success in providing a safe and scalable pathway for introducing vNOTES into new healthcare systems.
Collaboration and regional leadership
This milestone represents more than the introduction of a new surgical technique – it marks a significant collaboration between two leading professional bodies in women’s health. The initiative was driven by the joint efforts of Dr. Wael Hosni, Vice President of the Emirates Obstetrics and Gynecology Society (EGOS), and Prof. Dr. Fady Moiety, President of the Egyptian Society for Minimally Invasive Surgery (MISSE). Their collaboration reflects a growing regional commitment to advancing minimally invasive gynecologic surgery and strengthening cross-border professional exchange. By aligning the expertise and resources of both societies, the project has established a model for regional cooperation and created momentum for future joint initiatives aimed at improving surgical excellence and women’s health across the region.
The future of minimally invasive gynecologic surgery
The evolution of minimally invasive gynecologic surgery has progressed through distinct milestones. Conventional laparoscopy marked the first major shift away from open surgery, followed by the emergence of robotic-assisted surgery. Today, vNOTES represents the newest advancement in this continuum.
These milestones are not intended to replace one another; rather, they complement each other, expanding the spectrum of minimally invasive options and allowing surgeons to select the most appropriate approach for each individual patient.
The expansion of vNOTES signals a paradigm shift in the field of gynecologic surgery. With growing clinical evidence, increasing surgeon training, and strong regional collaboration, vNOTES is poised to become an integral part of minimally invasive gynecologic surgery.
