Study Objective The objective of this video is to demonstrate the use of vNOTES technique for performing vesicouterine dissection to obtain entry into the anterior peritoneal space in patients with prior Cesarean section and resultant vesicouterine scarring Design Case report. Setting Case was performed at an academic medical center with patient placed in the dorsal lithotomy position. Screen was positioned near the patient's head and facing towards the feet with surgeons positioned between the legs to operate within the vaginal orifice. Patients or Participants Patient undergoing vNOTES hysterectomy for the indication of abnormal uterine bleeding and pelvic pain. Patient had undergone prior cesarean section. Interventions vNOTES technique was used to facilitate visualization and access for development of the vesicouterine space and allow anterior peritoneal entry in the setting of scarring secondary to prior cesarean section. Measurements and Main Results Patient underwent total hysterectomy and bilateral salpingectomy with minimal blood loss and without intraoperative or postoperative complications. Conclusion vNOTES allows use of the natural vaginal orifice with improved visualization and access for dissection of vesicouterine adhesions allowing safe entry into the anterior peritoneal cavity and offers an alternative to abdominal laparoscopy in situations where a traditional transvaginal approach may not be feasible. The objective of this video is to demonstrate the use of vNOTES technique for performing vesicouterine dissection to obtain entry into the anterior peritoneal space in patients with prior Cesarean section and resultant vesicouterine scarring Case report. Case was performed at an academic medical center with patient placed in the dorsal lithotomy position. Screen was positioned near the patient's head and facing towards the feet with surgeons positioned between the legs to operate within the vaginal orifice. Patient undergoing vNOTES hysterectomy for the indication of abnormal uterine bleeding and pelvic pain. Patient had undergone prior cesarean section. vNOTES technique was used to facilitate visualization and access for development of the vesicouterine space and allow anterior peritoneal entry in the setting of scarring secondary to prior cesarean section. Patient underwent total hysterectomy and bilateral salpingectomy with minimal blood loss and without intraoperative or postoperative complications. vNOTES allows use of the natural vaginal orifice with improved visualization and access for dissection of vesicouterine adhesions allowing safe entry into the anterior peritoneal cavity and offers an alternative to abdominal laparoscopy in situations where a traditional transvaginal approach may not be feasible.