Is vNOTES the Michelangelo of Gynecologic Surgery?

Vaginal hysterectomy (VH) remains the original, minimally invasive natural orifice surgery. Despite its quicker execution than laparoscopic hysterectomy (LH) (39 minutes vs 72 minutes), VH detects fewer pelvic pathologies than its laparoscopic cousin (4.8% vs 16.4%, p ≤.01) [1]. However, it is no secret that VH rates have dwindled globally, despite economic and clinical advantages. This decline could be attributed to limited vaginal surgery training, increased laparoscopic training, increasing patient comorbidities, and more complex pathology that may compromise vaginal access and visibility.