Patient’s Preference Among the New Minimally Invasive Surgical Approaches – NOTES, Less and Mnilaparoscopy

GUSTAVO L CARVALHO, MD PhD, FLÁVIO A JÚNIOR, MD, JOSÉ S SILVA, STUDENT, CAMILA R CRUZ, STUDENT, DIEGO L LIMA, STUDENT, EDUARDO C CHAVES, STUDENT, REBECA G ROCHA, STUDENT, ADRIANO C SALES, STUDENT, RAFAELA L GOUVEIA, STUDENT. UNIPECLIN, Faculty of Medical Sciences, University of Pernambuco; Recife; Brazil

BACKGROUND: The recent advances in laparoscopic surgery presented to the world surgical community new approaches to surgical treatable diseases and developed new technologies that can be established in a near future. However, it is difficult to find in medical literature articles considering the patient’s preferences regarding these new surgical accesses.

OBJECTIVE: Identify patient’s preferences among the new different surgical approaches.

METHOD: The study was based on a questionnaire applied to medical students and medical doctors from a university hospital. A hundred thirty-five questionnaires were answered. There were 73 female and 62 male respondents. The majority of the persons (90%) was between twenty and twenty-nine years old. Before answering the questionnaire there was a brief information about the five available techniques (Open Surgery, Laparoscopy, Minilaparoscopy, LESS and NOTES). Hypothetically, the participant would be submitted to a cholecystectomy and must have a choice among the surgical approaches. The first question was related to the opting for the open method even though the others procedures were available. The second asked the participants if they would consider LESS and NOTES as options despite these techniques are not totally safe yet. At the third, they rank in order of their preferences the different offered methods. The fourth question excluded the Open Surgery and Laparoscopy and asked which was the preferred method among the new minimally invasive surgical approaches. The fifth was about the choice of a route for NOTES. At the sixth the respondent had to choose between LESS and Minilaparoscopy only. And the last question asked which is the most important factor to decide among the surgical approaches.

RESULTS: Overall, 62 participants would consider the possibility of open surgery, despite the four others options (LESS, NOTES, Laparoscopic and Minilaparoscopic). Seventy-three would not consider the open method. Among the new surgical approaches (LESS, NOTES and Minilaparoscopy), the most popular as first option to the procedure was Minilaparoscopy which had the preference of 63. After that was LESS with 35 and in third was NOTES with 21. Besides, if only NOTES, LESS and Minilaparoscopy (excluding Laparoscopy and open) were offered as options, the participants’ preference was the same with 102 (75,56%) choices to Minilaparoscopy. When only LESS and Minilaparoscopic were possible options, a hundred persons would prefer Minilaparoscopic against 35 who prefers LESS. The overall preference for the route of NOTES if only this approach was offered was the oral route with 86 persons. Thirty-two respondents do not have any specific choice. The majority of the participants (85,19%) chose the safety as the most important factor to make a decision. When was questioned about the safety of the procedure, a 110 respondents would not consider NOTES and LESS as therapeutic option unless these procedures have proved their safety and effectiveness.

CONCLUSION: Minilaparoscopy has been preferred by most patients who considered not only aesthetics but safety to be a very important factor when deciding for a surgical access. That makes to infer that questioned people consider Minilaparoscopy as the safest technique.