A RADICAL approach to abdominal surgery is gaining ground. Pioneered in India, it is being touted as one of the most significant developments in surgery for decades. Patients are left with no visible scar simply because surgeons go in through the mouth, reaching the abdominal cavity via incisions in the stomach wall.
Natural orifice translumenal surgery or NOTES has other potential benefits: it could reduce post-operative pain and the need for a general anaesthetic, speed up recovery times and cut the risk of infections (see 鈥淪car-free surgery through the mouth鈥�). So not surprisingly it has attracted a growing band of supporters. There is even a flurry of activity among inventive surgeons and medical device manufacturers to patent specialised instruments to make the procedure easier to perform.
Yet, before surgeons and patient groups start clambering onto the bandwagon, it is worth remembering that the benefits are still theoretical and need to be demonstrated in practice. Published studies of NOTES are thin on the ground. Its inventors, G. V. Rao and Nageshwar Reddy of the Asian Institute of Gastroenterology in Hyderabad, have yet to submit a comprehensive description of their work to a medical journal. If the rumours are true and they are about to do so, this would be welcome news. What we most need are trials comparing NOTES with conventional surgery to check out not just the benefits but also the risks accompanying the new procedures.
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Historically, surgery is notorious for following fashions and ignoring evidence 鈥� to the detriment of patients. Let us hope a more enlightened approach is taken with NOTES.
