Surgical Endoscopy

, Volume 26, Issue 11, pp 3163–3173 | Cite as

Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs

  • Mohammad Al-HaddadEmail author
  • Daniel McKenna
  • Jeff Ko
  • Stuart Sherman
  • Don J. Selzer
  • Samer G. Mattar
  • Thomas F. Imperiale
  • Douglas K. Rex
  • Attila Nakeeb
  • Seong Mok Jeong
  • Cynthia S. Johnson
  • Lynetta J. Freeman



Natural orifice transluminal endoscopic surgery (NOTES) has been mostly performed with the animal under general and inhalational anesthesia (IA-NOTES). To date, NOTES using propofol sedation (PS-NOTES) has not been investigated. This study aimed to assess the feasibility and safety of PS-NOTES for transgastric oophorectomy with carbon dioxide insufflation and to compare its success rates with those of conventional IA-NOTES.


In this prospective randomized study, NOTES oophorectomy was performed for 19 female dogs randomized to two conditions: PS (study group) and IA (control group). Sedation success rates (ability to visualize and resect ovaries without converting to IA), operative success rates (ability to resect and retrieve both ovaries in full using only NOTES), and vital parameters including hemodynamic and respiratory changes were documented.


In the PS-NOTES group (n = 9), the sedation success rate was 100 %. The operative success rate was 67 % (6 of 9 animals) compared with 80 % (8 of 10 animals) in the IA-NOTES group. No purposeful movement occurred during surgical manipulation and no respiratory or cardiovascular complications in occured the PS group. Heart rate (HR) and end-tidal carbon dioxide (ETCO2) were significantly higher in the PS group than in the IA group. Blood pressure (BP) was significantly higher in the PS group only during the middle part of the procedure. Only mild respiratory depression was noted in the PS group, as indicated by elevated but acceptable ETCO2. Elevations in BP and HR are thought to be related to elevated CO2 but did not appear to have an adverse impact on the course of the procedure. Recovery was uneventful for all the animals.


The use of PS-NOTES appears to be feasible, resulting in outcomes comparable with those for IA in dogs. Further studies are needed to determine the applicability of this concept in human NOTES.


Inhalational anesthesia NOTES Oophorectomy Propofol sedation 



This study was funded by the NOSCAR (2010) and the Glen A. Lehman Endowed Chair Fund in Gastroenterology.


Mohammad Al-Haddad, Daniel McKenna, Jeff Ko, Stuart Sherman, Don J Selzer, Samer G. Mattar, Thomas F. Imperiale, Douglas K. Rex, Attila Nakeeb, Seong Mok Jeong, Cynthia S. Johnson, and Lynetta J Freeman have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Mohammad Al-Haddad
    • 1
    Email author
  • Daniel McKenna
    • 2
  • Jeff Ko
    • 3
  • Stuart Sherman
    • 1
  • Don J. Selzer
    • 2
  • Samer G. Mattar
    • 2
  • Thomas F. Imperiale
    • 1
  • Douglas K. Rex
    • 1
  • Attila Nakeeb
    • 2
  • Seong Mok Jeong
    • 3
  • Cynthia S. Johnson
    • 4
  • Lynetta J. Freeman
    • 3
  1. 1.Department of Medicine, Division of GastroenterologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  3. 3.Purdue University School of Veterinary MedicineWest LafayetteUSA
  4. 4.Division of BiostatisticsIndiana University School of MedicineIndianapolisUSA

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