The Value Patients Assign to “Scarless” Laparoscopic Surgery

Sharona B Ross, MD1, Jamaal Hardee, MS2, Timothy Bourdeau1, Heather DeReus1, Indraneil Mukherjee, MD1, Christian B Rodriguez, BS1, Alexander S Rosemurgy, MD1. 1Florida Hospital Tampa, 2University of South Florida College of Medicine

Introduction: Laparo-Endoscopic Single Site (LESS) Surgery represents an evolution in minimally invasive surgery because surgeons forego multiple incisions, hopefully leading to no discernable scar or body image distortion. This study was undertaken to ascertain the value patients assign to “scarless” laparoscopic surgery.

Methods: Before their initial office visit, 604 patients (65% women; age 58 years; BMI 27 kg/m2) were surveyed about their body image utilizing a Likert scale (1=definitely disagree, to 5=definitely agree) and were asked to prioritize factors potentially associated with their impending LESS operation.

Results:  Patients were neutral about their body image when responding to prompts:

     

In considering LESS surgery relative to conventional laparoscopy, patients were willing to accept “no more risk” (69%), an operation “not longer in duration” (52%), “no additional pain” (67%), a recovery “not longer in duration” (61%), “no greater risk of incisional hernia” (76%), and “no increase in cost” (52%).  In prioritizing possible outcomes achieved with LESS surgery, patients rated (most to least important): risk, pain, operative duration, and cosmetic outcome (i.e., the lack of a scar) independent of BMI and sex; younger patients, however, were willing to undergo operations up to 50% longer if they resulted in no apparent scar (p<0.001).  Patients reported that it would not reduce their attraction to LESS surgery if an additional incision was made on their abdominal wall (86%) or side (83%).

Conclusions: Patients are neutral about their body image prior to proposed LESS surgery and generally do not assign great value to “scarless” laparoscopic surgery.  Several considerations are more important than cosmesis, particularly for older patients: risk, operative duration, pain, recovery time, risk of incisional hernia, and cost; cosmesis is more important in younger patients denoting that ‘some’ patients care very much about cosmesis.  This begs to question: “is there too much emphasis on cosmesis”? Since traditional laparoscopy is well tolerated and meeting patients’ needs, is traditional laparoscopy the end of the road for all but the younger patients? 

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