F1000: Taking NOTES - abdominal surgery without general anaesthesia

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Can abdominal organs be removed with only regional pain relief? A recent review in Faculty of 1000 Medicine Reports, a publication in which clinicians highlight advances in medical practice, suggests this might be possible in the future. In this review, Michael Schaefer writes that a new approach to abdominal surgery could be performed without the need for general anaesthetics.

Core Facts

Currently, abdominal surgery is often carried out through laparoscopy, in which surgical tools are manoeuvred through several small incisions in the abdominal wall under general anaesthetics. But in an emerging technique, Natural Orifice Transluminal Endoscopic Surgery (NOTES), the organs are reached through a natural opening in the body, such as the mouth or the vagina.
This type of surgery is not yet a mainstream procedure. “NOTES procedures in patients have been reported worldwide in only about 30 cases”, Schaefer emphasizes. Patients may prefer it because of low postoperative pain discomfort and because of a lack of visible scarring. Schaefer points out that NOTES may also be beneficial from an anaesthetic point of view. The small perforations of the gastric or vaginal wall that are needed to accommodate the surgical tools and the low intra-abdominal pressure that is needed for best visibility may only require spinal or epidural anaesthesia.

Relevant Files

Name: shaefer-report.pdf, Size: 104233 bytes, Download

Quotes

Michael Schaefer, Faculty Member for F1000 Medicine and Professor of Anesthesiology at Charité University Berlin

Combined with a quick recovery time, low pain levels after surgery and complete absence of visible scars, this may eventually make NOTES the preferred method for abdominal surgeries. “NOTES has the potential to further improve the advantages of laparoscopy”, writes Schaefer, but advises that “these findings need to be corroborated by further randomized controlled clinical trials.”