Saint James Private Healthcare has become the first facility in Malta's private sector to perform a scarless hysterectomy using an advanced technique that removes the uterus entirely through the vagina, eliminating any need for visible abdominal incisions. The procedure represents a meaningful shift for women facing gynecological surgery, promising less pain, faster recovery, and no external scarring.
Why This Matters
• Shorter recovery: Most patients return to daily activities within 3 to 7 days, compared to 6–12 weeks for traditional abdominal surgery.
• No visible scars: The entire procedure is performed through the vagina, leaving no external marks.
• Less pain: Clinical data shows significantly lower pain scores in the first 24 hours compared to conventional laparoscopy.
• Same-day discharge possible: Many vNOTES patients qualify for discharge within 24 hours, reducing hospital stays and related costs.
The vNOTES Technique Explained
The procedure—formally known as Vaginal Natural Orifice Transluminal Endoscopic Surgery—is performed by inserting a specialized camera and surgical instruments through a small incision inside the vagina. The abdomen is then inflated with carbon dioxide to create working space, allowing the surgical team to visualize the uterus, fallopian tubes, and ovaries on high-definition monitors.
At Saint James Hospital, a six-member team led by consultant obstetrician and gynecologist Dr. Johann Craus completed the institution's first vNOTES hysterectomy in August. The hospital employs a state-of-the-art 4K laparoscopic imaging system to ensure precision during the procedure, which is generally quicker than traditional laparoscopic surgery.
Once the uterus is detached from surrounding structures, it is removed through the vaginal canal. Internal sutures are absorbable, and patients leave the operating theater with no external wounds.
What This Means for Patients
For eligible women, the benefits extend well beyond cosmetics. Traditional abdominal hysterectomy requires a 6 to 12-inch incision, leading to a hospital stay of up to six days and a recovery period that can stretch beyond two months. Even conventional laparoscopy—considered minimally invasive—requires multiple small "keyhole" incisions on the abdomen and carries a 2 to 4-week recovery window.
vNOTES bypasses these trade-offs. Patients report earlier return of bowel function, often within 48 hours, and are able to walk sooner after surgery. Pain medication requirements are lower, and the absence of abdominal incisions reduces the risk of wound infections, hernias, and other port-related complications.
The technique is suitable for treating uterine fibroids, abnormal uterine bleeding, chronic pelvic pain, and uterine prolapse. Beyond hysterectomies, vNOTES can also be applied to selected procedures involving ovarian cyst removal or fallopian tube excision.
However, not all patients are candidates. A thorough clinical assessment is mandatory. Women with advanced endometriosis, extensive pelvic scarring, or significantly enlarged uteri may require a different surgical approach. Higher BMI and complex gynecological conditions can also affect eligibility or lead to conversion to a different technique mid-procedure.
How Malta Compares Regionally
Malta's private healthcare sector is now aligned with select centers in southern Europe offering vNOTES. In January, Ospedale Umberto I in Enna, Sicily, completed its first vNOTES hysterectomy under the direction of Professor Basilio Pecorino. Tertiary referral centers in Italy—including Niguarda Hospital in Milan, Cannizzaro Hospital in Catania, and the University of Pisa—have contributed to the initial Italian clinical experience with the technique.
While several hospitals across Malta and the Mediterranean offer traditional laparoscopic and robotic-assisted hysterectomy, Saint James Private Healthcare is the first in Malta's private sector to bring vNOTES to patients. The technique is not yet confirmed to be widely available across public health facilities on the island, meaning access may be limited for patients without private insurance or the ability to pay out-of-pocket.
The Cost-Benefit Calculation
Despite the initial expense of equipment and training, vNOTES can be more cost-effective over time due to shorter surgical duration, reduced hospital stays, and lower complication rates. Patients who return to work within a week rather than two months also reduce the indirect economic burden of extended sick leave.
The American College of Obstetricians and Gynecologists (ACOG) recommends vaginal hysterectomy approaches, including vNOTES, whenever feasible, citing the advantages of reduced recovery time and lower morbidity compared to abdominal methods.
For women living in Malta, the introduction of vNOTES at Saint James represents a tangible improvement in surgical options—particularly for those prioritizing a faster return to professional and family responsibilities. The technique also holds appeal for patients concerned about body image and the psychological impact of visible surgical scars.
Broader Applications and Future Outlook
Research in 2026 suggests that vNOTES may extend beyond hysterectomy. Myomectomy for fibroid removal using the same transvaginal approach is under evaluation, offering another scarless option for women who wish to preserve their uterus. The technique's capacity to minimize the body's inflammatory response positions it within a broader "wellness-first" surgical philosophy that prioritizes rapid recovery and reduced physical trauma.
Clinical outcomes across multiple studies indicate that vNOTES patients experience shorter operative times, lower blood loss, and fewer readmissions compared to both traditional vaginal surgery and conventional laparoscopy. Postoperative quality of life scores and sexual function metrics show significant improvement, contributing to higher patient satisfaction.
However, the procedure's success depends heavily on surgeon experience and patient selection. Facilities offering vNOTES must invest in specialized equipment—such as the GelPOINT® V-Path transvaginal access platform—and ensure their surgical teams are trained in endoscopic techniques performed through a natural orifice rather than abdominal ports.
What You Should Know Before Considering vNOTES
If you are contemplating a hysterectomy, the following factors should guide your conversation with your gynecologist:
• Eligibility: Request a detailed assessment of your uterine size, prior surgical history, and any pelvic conditions that might affect candidacy.
• Recovery expectations: While most patients recover quickly, individual outcomes depend on factors like age, overall health, and the complexity of the surgery.
• Cost and insurance coverage: Confirm whether your private insurance covers vNOTES at Saint James or if you will need to pay out-of-pocket. Recovery time and reduced sick leave may offset upfront costs.
• Surgeon experience: Ask how many vNOTES procedures the surgical team has performed and what their complication and conversion rates are.
The shift toward scarless, transvaginal surgery marks a meaningful evolution in women's healthcare on the island. For the right candidates, vNOTES offers a combination of clinical and lifestyle benefits that traditional methods cannot match—particularly for women seeking minimal disruption to their daily routines and professional obligations.
