title: Patient preferences for surgical techniques: should we invest in new approaches?
abstract: BACKGROUND
  The face of surgery has changed over the past two decades with the introduction of laparoscopic techniques. The majority of surgical specialties now perform minimally invasive procedures hence decreasing the scarring, pain, and infection historically associated with open surgery. To further reduce the invasiveness of surgery, new surgical techniques like Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single-Port Surgery (SPS) are under development. Despite investment from the medical device industry and enthusiasm from medical professionals, we must analyse patient preferences and expectations of these novel techniques. This analysis will help us establish the demand for such techniques and guide future resource allocation.
  
  
  METHODS
  A questionnaire-based study was derived to identify whether the concepts of innovative techniques are acceptable to the general population. Their preferences between different available surgical options were recorded along with their choices for new innovative techniques. This study was carried out face-to-face and by using an online survey. It comprised four questions based upon a hypothetical scenario of an acute appendicitis. All the data were captured in a prospective database and analysed using statistical software.
  
  
  RESULTS
  A total of 750 participants from variable backgrounds took part in the study. NOTES or SPS without an established safety profile was accepted by 34.3% of patients. SPS was the most popular method followed by conventional laparoscopy. Open surgery and NOTES were the least preferred (ranked 1.78, 1.98, 2.94, and 3.27, respectively). Choosing between SPS and NOTES only, 80.6% opted for SPS, 11.8% NOTES, and 5.6% declined surgery. The most popular route of access for NOTES is oral (37.7%).
  
  
  CONCLUSIONS
  Single-port surgery was the most preferred method and NOTES was the least preferred technique. This shows general acceptance of the concept of virtually scarless surgery but without using the natural orifices.
authors.affiliation: Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, AB25 2ZA, UK. a.rao.03@aberdeen.ac.uk
authors.forename: Ahsan
authors.initials: A
authors.lastname: Rao
authors.forename: James
authors.initials: J
authors.lastname: Kynaston
authors.forename: Euan R
authors.initials: ER
authors.lastname: MacDonald
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires; D055815:Young Adult