News Release

Taking NOTES: abdominal surgery without general anesthesia

Can abdominal organs be removed with only regional pain relief?

Peer-Reviewed Publication

Faculty of 1000

A recent review in Faculty of 1000 Medicine Reports, a publication in which clinicians highlight advances in medical practice, suggests regional pain relief could be used during abdominal surgery. In this review, Michael Schaefer recommends a new approach that can be performed without the need for general anaesthetics.

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.

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."

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Notes to Editors

1 Michael Schaefer, Faculty Member for F1000 Medicine, is Professor of Anesthesiology at Charité University Berlin http://f1000medicine.com/about/biography/2806447008018379

2 The full text of the article "Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia" is available for subscribers at http://f1000medicine.com/reports/10.3410/M1-80/

3 Please name F1000 Medicine Reports/Faculty of 1000 Medicine in any story you write. If you are writing for the web, please link to the website.

4 F1000 Medicine Reports (ISSN 1757-5931) publishes short commentaries by expert clinicians focussing on the most important studies identified by Faculty of 1000 Medicine that are likely to change clinical practice. The commentaries summarise the implications of important new research findings for clinicians.

5 Faculty of 1000 Medicine, http://f1000medicine.com, is a unique online service that helps you stay informed of high impact articles and access the opinions of global leaders in medicine. Our distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.

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