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Minimally invasive surgery in Gynecology

General Hospital Zadar, University of Zadar

Program Overview – Gynecology (vNOTES & Advanced Minimally Invasive Surgery)

Overall, we can provide fellows with a comprehensive and high-volume exposure to advanced minimally invasive gynecologic surgery, with a particular focus on vNOTES techniques. Training is offered in a collaborative, hands-on, and educational environment. A typical weekly surgical case-mix may include:

4–6 vNOTES hysterectomies

3–5 vNOTES adnexectomies

1–2 vNOTES retroperitoneal sentinel lymph node biopsies (often combined with vNOTES hysterectomy + BSO)

1–2 vNOTES high sacrouterine ligament suspensions (HSULS)

1–2 vNOTES autologous posterior fascial graft procedures (rectus fascia transplantation for total prolapse — PREFAP–type)

1 case of deep infiltrating pelvic endometriosis

Fellows are welcome to attend all procedures and may participate as second assistants, providing meaningful operative exposure while ensuring a safe and structured learning experience.

Main Areas of Interest

1. Main Interest

The Department of Gynecology and Obstetrics consists of 20 specialists, including 3 subspecialists in gynecologic oncology, 1 in urogynecology, 2 in human reproduction, and 5 in fetomaternal medicine. Our operative program is predominantly based on minimally invasive surgery, including office hysteroscopy and laparoscopy. Approximately 80% of all procedures are minimally invasive, with a total annual volume of around 1,200 surgical interventions.

Our department is the first in Croatia and in the broader Eastern European region to integrate vNOTES into its clinical portfolio. Since its introduction in 2022, we have performed more than 400 vNOTES procedures. We have also developed several surgical techniques that are practiced in only a few centers worldwide. Examples include vNOTES approaches for the treatment of endometrial cancer, as well as various advanced urogynecological procedures such as HSULS and PREFAP (autologous tissue transplantation in total prolapse).

A large number of gynecologists from across Croatia have received hands-on vNOTES training in our department, enabling the implementation of this technique in routine clinical practice. In addition, our department is actively involved in several international research collaborations, including the VANOLAH Trial, ADNOLA Trial, and SENTICOL Trial.

Zadar, where our hospital is located, is one of the most beautiful cities in Croatia and is renowned for having one of the most stunning sunsets in the world—well worth experiencing in person.

Specialties

Gynecology

Surgical Oncology

Techniques You Will Learn

Brief Descriptions of Surgical Techniques

vNOTES Hysterectomy

A minimally invasive transvaginal approach that avoids abdominal incisions and allows excellent visualization of pelvic anatomy. The technique offers rapid recovery, minimal pain, and high surgical precision.

vNOTES Adnexectomy

Removal of ovaries and/or fallopian tubes through a natural orifice using vNOTES access. Provides safe dissection of pelvic sidewall structures with minimal postoperative discomfort.

vNOTES Retroperitoneal Sentinel Lymph Node Biopsy (+ vNOTES Hysterectomy/BSO)

An advanced staging procedure that enables precise retroperitoneal lymph node mapping and removal without abdominal trocars. Often combined with hysterectomy in early endometrial cancer management.

vNOTES High Sacrouterine Ligament Suspension (HSULS)

A minimally invasive repair for apical prolapse achieved by placing suspension sutures high on the sacrouterine ligaments. Restores pelvic support while preserving vaginal function.

vNOTES Autologous Posterior Fascial Graft (Rectus Fascial Transplant for Total Prolapse)

A reconstructive procedure using the patient’s own rectus fascia to correct advanced prolapse. Provides durable support and avoids the use of synthetic materials.

Deep Pelvic Endometriosis Surgery

Management of infiltrative disease affecting the pelvic sidewall, uterosacral ligaments, or rectovaginal space. Requires meticulous dissection to restore anatomy and reduce pain.

Curriculum

Can Be Customized

A brief introduction and orientation will be followed by gradual integration into the trainee group. Fellows will have access to the departmental induction materials and will be encouraged to participate in all teaching rounds, multidisciplinary meetings, and morning handover sessions. They will also have the opportunity to shadow senior registrars in their daily clinical work to gain a clear understanding of the workflow within the Department of Gynecology and Obstetrics.

Subject to occupational health clearance, fellows will be allowed to observe in the operating theatres, with exposure to advanced minimally invasive procedures such as vNOTES, laparoscopy, urogynecologic reconstruction, and complex pelvic surgery. In selected cases, and when appropriate from a clinical and safety perspective, fellows may also be able to assist during procedures, providing a valuable hands-on learning experience.

Our department is currently in the process of becoming an accredited GESEA Training Center, enabling fellows to use our dry-lab infrastructure to practice and develop laparoscopic and endoscopic skills in a structured setting.

Accommodation

Accommodation in Zadar is generally not an issue, as the city is compact and most locations are within a 10-minute walking distance. There are also several hotels conveniently located directly across from the hospital, such as Hotel Kolovare, Miramare Hotel, and Hyatt Hotel Zadar. All of these options are easily accessible and can be booked through standard platforms such as Booking.com.

Fees and Program Logistics

This program has the following durations available:

Duration	Fee
2 weeks	$1,089.00

This program allows Merit Applications. This program allows merit-based applications for virtual and onsite clinical and research programs. If you are successfully awarded under this category, Trialect or the host mentor will cover the tuition fee only. All applications will be evaluated based on merit. Due to the high level of competition, the chances of being selected under the merit category are quite limited.

Who Can Apply

Applicants should meet the following criteria to be considered for the fellowship:

Completed residency in Obstetrics and Gynecology, or currently in a senior stage of training with sufficient operative experience

Basic proficiency in laparoscopy, including skills in camera handling, two-handed instrument manipulation, and standard benign gynecologic procedures

Familiarity with pelvic anatomy and minimally invasive surgical principles

Demonstrated interest in vNOTES or minimally invasive gynecologic surgery, preferably with prior attendance of introductory workshop but not mandatory

Ability to participate in clinical observation and, when appropriate, selected hands-on assisting

Fluent inEnglish to ensure safe communication within the clinical team

Additional preference may be given to candidates who:

Have prior experience in vaginal surgery or natural orifice approaches

Are practicing urogynecology, endometriosis surgery, or pelvic reconstructive surgery

Host Details

Host Name: Luka Matak

Affiliation: General Hospital Zadar, University of Zadar

Address: Bože Peričića 5,23000 Zadar Croatia, Gynecology Department

Website URL: https://www.bolnica-zadar.hr/

Disclaimer:It is mandatory that all applicants carry workplace liability insurance, e.g., https://www.protrip-world-liability.com (Erasmus students use this package and typically costs around 5 € per month - please check) in addition to health insurance when you join any of the onsite Trialect partnered fellowships.

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