Laparoendoscopic single-site surgery patients consider scarring low in importance

Chicago-Improved cosmesis is considered the primary advantage of laparoendoscopic single-site surgery (LESS) compared to other procedures, but patients consider this outcome to be of low importance, a recent study indicates.

LESS, or "scarless surgery," as it is sometimes called, is typically conducted through the umbilicus, where the resulting scar is hidden by umbilical folds, hence the term "scarless." Although the outcomes of LESS procedures in experienced hands can be equivalent to those seen in comparable procedures, researchers say LESS has yet to show definitive clinical benefits other than improved cosmesis.

Thus, researchers from two centers set out to determine where patients place cosmesis in the hierarchy of outcomes associated with different surgical approaches. Surgeons at the University of Texas Southwestern Medical Center, Dallas, and the University of Iowa, Iowa City surveyed 78 patients undergoing conventional laparoscopic kidney procedures (32 patients), LESS kidney procedures (15), open kidney procedures (10), laparoscopic prostate procedures (16), or open prostate surgery (five).

Surgeon reputation and the risk of complications were the two most important considerations cited by patients, reported co-author Chad Tracy, MD, assistant professor of minimally invasive, laparoscopic, and robotic urologic surgery at the University of Iowa. The study was conducted under the guidance of Jeffrey Cadeddu, MD, of UT Southwestern.

"Cosmesis appears to be the overwhelming advantage of LESS surgery, but much of this opinion is based on subjective observations by surgeons," Dr. Tracy told Urology Times. "We wanted an objective measure that would allow us to determine how many patients felt cosmesis was important and who they were.

"A substantial majority of the patients we operate on don't particularly care about cosmesis; at least they don't appear to care preoperatively."

Younger patients care about cosmesis

However, Dr. Tracy, who presented the findings at the 2010 World Congress of Endourology and SWL in Chicago, noted that there is a subset of patients, consisting mainly of those who are younger and those who are being operated on for benign conditions, who do care about cosmesis.

"This makes sense," he said. "If a patient is being treated for cancer, his first concern is to get the cancer cured with no complications.

"But if a patient is coming in for something that is not life threatening or does not involve cancer, then he may be more concerned about the cosmetic benefits of a treatment," Dr. Tracy explained.

The average age of the patients in the study was 54.1 years. Most (61.5%) were male. Patients were given a preoperative questionnaire designed to evaluate their attitudes toward the importance of surgical outcomes. They also completed a modified version of the Standardized Body Image Questionnaire.

Younger patients (<50 years), patients with benign conditions, and those with a history of minimally invasive surgery valued cosmesis more than others in the cohort, but none ranked it as their primary concern.

Dr. Tracy said that it is probably too early to assess the full clinical value or potential of LESS procedures. He said a few studies suggest that patients have less pain and faster recovery following LESS procedures.

The researchers concluded that before cosmesis can be given full consideration, LESS must produce outcomes equivalent to those seen with traditional laparoscopy, with no increase in the risk of complications.