New minimally invasive gynecologic procedures offer patients more options, greater benefits

Vital Signs Winter 2024
patient and doctor

UCLA’s expanding menu of minimally invasive gynecologic surgeries (MIGS) provides a host of benefits for patients: lower risk of complications, less scarring and shorter recovery times. Along with excellent outcomes, there’s another big benefit: options. 

Among those options are two relatively new procedures first introduced to Southern California at UCLA: vaginal natural orifice transluminal endoscopic surgery (vNOTES) and transcervical radio-frequency ablation for fibroids, known as Sonata. 

“The first time I saw vNOTES, my mind was blown,” says Sukrant Mehta, MD, assistant clinical professor of OB-GYN. “I thought, ‘Making use of a natural orifice is pure genius.’ We make an incision high in the apex of the vagina where the patient will never see it, and it’s not very painful.” 

Through that incision, surgeons inflate the abdomen and pelvis and insert small portals where a camera and surgical instruments go through. “It’s a new approach using FDA-approved instrumentation specifically for vaginal laparoscopic surgery,” explains Ram Parvataneni, MD, co-director of UCLA Health’s Fibroid Treatment Program. “Cases including hysterectomies, ovarian surgeries, cyst removal, and fallopian tube surgeries have gone very well. We’re extremely happy with the outcomes.” And because there are no visible incisions, healing is faster than with traditional laparoscopy. 

“New technologies and different techniques provide options attuned to patients’ preferences. Staying on top of new options, and educating patients about them, is one of the most important ways we provide optimal care.

While vNOTES involves a small incision, Sonata is performed without any skin incision.  “That’s an incredibly important distinction,”  
Dr. Parvataneni says.  

An ultrasound probe is inserted through the cervix and into the uterine cavity, allowing the surgeon to identify borders of fibroids inside the uterus, Dr. Mehta explains. “We then use an array of needles to treat the fibroid. The fibroid tissue is heated to 105-degrees C, higher than the boiling point of water, causing the fibroid cells to be destroyed, without affecting the surrounding normal uterine tissue.” 


Over time, the tissue gets softer and shrinks. “This has a huge impact on how fibroids affect patients, which can include heavy menstrual bleeding, pelvic pain, pelvic pressure, urinary symptoms, constipation and more,” Dr. Mehta says. 

Kathryn Goldrath, MD, assistant clinical professor of OB-GYN, stresses how important advances in fibroid treatment are. “It’s estimated about 70% of premenopausal women are diagnosed with fibroids at some point. For Black women, that risk can be upwards of 80%,” she says. “It’s an important statistic. I have a lot of patients who come to me, and the first thing they say is, ‘I have fibroids, but don’t take out my uterus.’” 

Historically, certain populations, including African Americans, have felt distrust toward the medical community because of the many health injustices historically inflicted upon them. So, new technologies and different techniques, such as incision-free Sonata, provide options attuned to patients’ preferences, Dr. Goldrath says. “Staying on top of new options, and educating patients about them, is one of the most important ways we provide optimal care,” she says. 

Dr. Parvataneni points out that both vNOTES and Sonata are covered by most health insurance plans, including government payers, helping to ensure access to care. “We want to take care of everyone,” he stresses, “and this provides opportunities for all patients to receive the best care.” 

vNOTES and Sonata are part of the full menu of MIGS procedures available at UCLA Health, and they will, over time, assume greater roles in the treatment of women requiring gynecologic surgery.  “This,” says Dr. Goldrath, “is the future of gynecologic surgery.” 

More information about minimally invasive gynecologic surgery