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A Physician Performs His Own Surgery Under Epidural Anesthesia

A recent case highlights an unusual and controversial clinical scenario—a physician performing abdominal surgery on himself under regional anesthesia.

The case

A 40-year-old obese physician with multiple cardiovascular risk factors sought abdominoplasty following significant weight loss (145 kg to 90 kg). Despite improved metabolic control, several surgeons declined to operate due to high cardiac risk.

As a result, the physician decided to perform the procedure himself.

The surgery was conducted under thoracic epidural anesthesia with ropivacaine, selected for its lower cardiovascular risk profile. The procedure included extensive abdominal dissection, umbilical repositioning, and wound closure using sutures and staples. A standby plastic surgeon was present in case of complications.

Intraoperative course

Preoperative management included fluids (Ringer’s lactate) and ondansetron. Local anesthesia consisted of lidocaine with adrenaline.

During the procedure, the patient experienced:

  • hypotension (85/46 mmHg)
  • bradycardia (HR 48/min)

These were managed with atropine, ephedrine, and fluid administration.

A second episode of hypotension (100/65 mmHg), accompanied by dizziness, was resolved by placing the patient in a recumbent position.

Outcome

Recovery was uneventful:

  • return to work within 5 days
  • staple removal after 10 days
  • satisfactory surgical outcome

Why this case stands out

This case raises important considerations:

  • the use of regional anesthesia in high-risk cardiac patients
  • the limits of surgical autonomy and decision-making
  • risk-benefit assessment in patients declined for standard care

While clinically successful, self-performed surgery remains highly unconventional and raises ethical and safety concerns.

Conclusion

The case illustrates how tailored anesthetic strategies can reduce perioperative risk in complex patients. At the same time, it highlights the importance of structured clinical decision-making and the boundaries of acceptable medical practice.