Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery

作者：Olweny Ephrem O; Mir Saad A; Best Sara L; Park Samuel K; Donnally Chester III; Cadeddu Jeffrey A^*; Tracy Chad R

来源：BJU International, 2012, 110(2): 268-272.

DOI：10.1111/j.1464-410X.2011.10784.x

• laparoscopy
• cosmetic techniques
• patient preference

OBJECTIVE %26lt;br%26gt;To evaluate patient attitudes towards cosmesis relative to other considerations, before and after undergoing laparoendoscopic single-site surgery (LESS) vs laparoscopic/robot-assisted vs open kidney surgery. %26lt;br%26gt;METHODS %26lt;br%26gt;Participants were provided with a survey querying demographic information, surgical history and importance of scarring relative to other surgical outcomes and considerations. %26lt;br%26gt;The relative importance of each outcome was recorded on a nine-level ranking scale, ranging from 1 (most important) to 9 (least important). %26lt;br%26gt;The median scores for each outcome were compared before and after surgery using the Wilcoxon signed-rank test, and by surgical approach using the Kruskal Wallis test. %26lt;br%26gt;The importance of scarring was further analysed according to age (%26lt;= 50 vs %26gt;50 years), surgical indication (oncological vs non-oncological), gender, and proportion of patients who had undergone previous abdominal surgery. %26lt;br%26gt;RESULTS %26lt;br%26gt;A total of 90 patients completed surveys before surgery, of whom 65 (72.2%) also completed surveys after surgery. %26lt;br%26gt;%26apos;Surgeon reputation%26apos; and %26apos;no complications%26apos; were the most important considerations before surgery (median scores 2 and 3, respectively) and after surgery (median scores of 2 for both). %26lt;br%26gt;%26apos;Size/number of scars%26apos; was the least important consideration before surgery (median score 8) and the second least important consideration after surgery (median score 7). %26lt;br%26gt;The median score for %26apos;size/number of scars%26apos; was significantly higher for the LESS cohort before surgery (laparoscopic/robot-assisted vs LESS vs open surgery: 8.5 vs 6 vs 9; P = 0.003), but was nonsignificant after surgery (laparoscopic/robotic vs LESS vs open surgery: 7 vs 6.5 vs 7.5; P = 0.83). %26lt;br%26gt;The median score for %26apos;size/number of scars%26apos; before surgery was significantly higher for younger patients (P = 0.05) and those with non-oncological surgical indications (P %26lt; 0.001), but there was no significant difference in this outcome for these sub-groups after surgery. %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;For most patients contemplating urological surgery, cosmesis is of less concern than surgeon reputation and avoidance of surgical complications. %26lt;br%26gt;Cosmesis may be a more important preoperative consideration for younger patients and those with benign conditions, which warrants further investigation.

• 出版日期2012-7