‘Scarless’ surgery? Check out NOTES

Surgery is a daunting prospect. The thought of another human-being rummaging around in your insides is enough to turn anybody a bit pale with worry. Oh- and as an added bonus- the chances are, you are going to be left with a lovely scar to commemorate the event.

Well actually, that may not necessarily be true…

Pushing the boundaries of existing minimally-invasive technologies, surgeons are currently attempting the amazing feat of being able to complete certain procedures without the need for incisions. Via, shall we say, naturally existing access routes within the body.

Yes: it is what you are thinking.

The rectum, vagina, urethra and also the mouth are all channels utilized in NOTES (Natural Orifice Transluminal Endoscopic Surgery) in order for doctors to gain access to internal areas needing to be operated on.

The basic principle of NOTES has been an established means for diagnostic tests and simple therapies for a while- for example, inserting a camera into the throat to better view of internal structures (known as endoscopy). Now however, this technology is being explored in an exciting new capacity.

The potential to be able to complete full surgical procedures through already-present orifices in the body, means that new openings do not have to be created and therefore surgeons can try to avoid putting patients through the physical trauma of being cut open. Instruments, including a camera, can be inserted into these sites, allowing for surgeries to be performed in an incredibly minimally invasive way.

When compared with conventional laparotomy (standard open surgery, requiring a substantial incision into the abdomen) and laparoscopy (minimally invasive surgery, which uses small incisions into the abdomen, followed by the insertion of instruments into the body via ports), NOTES comes with a range of potential benefits.

The major advantages can mostly be attributed to the lack of an external wound site. This key achievement of NOTES means that the patient does not have to suffer the additional pain of wound-healing; does not have the risk of developing an incisional hernia and crucially; has reduced risk of surgical site infection.

Post-operative infection is one of the most common complications of surgery and can be deadly; by taking away an external healing site it severely reduces the chances of germs getting to the surgical site and creating a nasty infection.

Added to this, there could also be a reduced requirement for anaesthesia and shorter hospital stays too. But inherently unique to this surgery, is that it is ‘scarless’. This is even to the extent that on occasions when another camera is needed to be inserted from the outside, a very small incision is made into the belly button, in such a location whereby the cut will be hidden within folds of the skin.

Research and training are currently in progress to help propel NOTES to its full potential. With this technology already proving its feasibility in human trials, mainly in the field of general surgery- from removal of the appendix to biopsies to the treatment of intestinal cancers- it may not be too long before this technique establishes itself as a significant evolutionary step in modern surgical methods.

Photo credit: TopNews.in

“Like a patient etherized upon a table”: The horror of anaesthetic awareness

Whilst the statistical likelihood of finding yourself awake on the surgical operating table is less than 0.5%, the horrific idea of ‘anaesthetic awareness’ remains active in the popular consciousness. Although grouped under the title ‘general anaesthesia’, in fact anaesthesiologists administer a wide range of different drugs to place their patient into a sustained state of unconsciousness.

Despite the fact that televised medical dramas have made many of us familiar with the notion of being ‘put to sleep’ (we’ve all seen the injection of an induction agent such as sodium pentathol being given to the patient just before they’re wheeled into theatre), the process of anaesthesia is much more complex. After injecting this first drug, the anaesthesiologist also typically gives his patient an opiate (which works as a pain-eradicating analgesic), a benzodiazepine to reduce anxiety and a neuromuscular ‘blocking’ agent such as vecuronium. This sleeping state is then maintained by having the patient breathe oxygen laced with a vaporized liquid anaesthetic such as isoflurane.

Whilst medical advances have made anaesthesia the safest it has ever been, there are inevitably certain subsections of society who are more at risk of experiencing anaesthetic awareness. Although steps can be taken to offer alternative drugs to patients with medical conditions that would put their health in danger (like those with low blood pressure or women who require emergency caesarean operations) there will always be a margin of risk for anyone who undergoes surgery. Indeed, it is clear that any error in planning – no matter how small – could see the paralysing effects of a neuromuscular blocking agent become catastrophic for the patient. Even though the agent is used with very good reason (anaesthesia slows down the patient’s respiration rate and the paralysis induced by a neuromuscular blocker facilitates effortless control over their breathing), the fact that neuromuscular drugs make no impact on the patient’s consciousness leaves them vulnerable to an unimaginably horrific experience.

Certainly, in the event of any mishap (unanticipated patient tolerance, human or mechanical fault or if the other anaesthetic agents prove insufficient) then the patient is potentially left wide awake, unable to move and terrified. Whilst the clues are there for an observant anaesthesiologist (an increase in blood pressure and heart rate show that the anaesthesia is wearing off slightly), there is always a chance this could be missed.

Statistics vary on the specifics, but there is no doubt that anaesthetic awareness causes deep psychological effects for those who experience it. Although anaesthesia awareness remains relatively rare, the anxiety suffered by those who experience it should not be underestimated, with over 70% of victims experiencing lasting psychological symptoms for the rest of their lives. With such troubling and traumatic potential effects from anaesthesia, it’s no wonder that there are now medical negligence claims specialists helping people secure compensation for this horrible ordeal.