Yueyang Fei, Mario Salazar, MD, Jeffrey W Hazey, MD
The Ohio State University Wexner Medical Center
Background
Past studies comparing transvaginal NOTES (Natural Orifice Translumenal Endoscopic Surgery) to laparoscopic surgery have produced a wide variety of conflicting results. Varying results have been presented from those that demonstrated a preference for or positive perception of TVC to those which found a negative perception of and aversion to TVC as a surgical option. In light of the disparity in results, our study aimed to identify demographic data as well as clinical factors (risks, outcomes, etc.) that significantly affected women’s opinions. Once specific considerations are identified as important in the decision-making process regarding NOTES, further studies may better investigate and assess how these factors help formulate women’s perceptions.
Methods
142 Female patients presenting to General and GI surgery clinics for consultation were surveyed. After explanation and discussion of both laparoscopic cholecystectomy and TVC, patients answered a 10 question survey regarding the degree of importance they placed on common general surgery as well as TVC outcomes and complications. They were also queried as to their degree of concern over training and possible advantages of TVC in particular as well as possible preference for TVC over LSC. Demographic, social, and medical history data were collected on all patients who participated. χ2 analysis was performed to test for association between women’s concerns and their preference for transvaginal NOTES over the standard laparoscopic surgery.
Results
Overall, a small majority of respondents (55%) would choose TVC over LSC. For women who would choose TVC over LSC, a potentially shortened recovery time and improved post-surgical cosmesis were found to be the most significant factors affecting their decision. Despite concerns over common complications such as infection and post-surgical pain (around 70% rated each a significant concern), neither appeared to influence a patient’s preference for TVC or LSC. Age was the only statistically significant demographic factor that affected women’s preferences. 35% of women younger than age 36 would choose transvaginal NOTES whereas 63% and 61% of women ages 36-55 and older than age 55, respectively, would prefer the transvaginal technique. No other demographic data appeared to be significant in patient’s choice of procedures.
Conclusions
Our study further adds support to the idea that cosmesis and age are critical factors in women considering TVC over LSC. As such, we believe there is further need for research into these two factors and why they have or have not translated into increased number of TVC procedures being done. In addition, if age and cosmesis are important does it follow that geography and cultural factors also play a role? Finally, despite an overall positive response and even preference for TVC in most studies including ours, TVC has been slow to become a standard procedure or option. As such, future studies will need to move away from questions regarding perceived risks and delve into more personal, and possibly more important, social and cultural factors which complicate the issue of perception. If we do not, then the disconnect between the slow adoption of TVC despite its positive perceptions cannot be understood.
Session: Poster Presentation
Program Number: P582
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