title: Population perception of surgical safety and body image trauma: a plea for scarless surgery?
abstract: BACKGROUND
  Laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES) are prospected as the future of minimally invasive surgery. While scarless surgery (NOTES and LESS) is gaining increasing popularity, perception of these approaches should be investigated.
  
  
  METHODS
  An anonymous questionnaire describing laparoscopy, LESS, and NOTES was given to medical staff (n=120), paramedical staff (n=100), surgical patients (n=100), and the general population (n=100). The survey participants (median age, 37 years; range, 18-81 years) were queried about their expectations for surgical treatment and their approach preference.
  
  
  RESULTS
  The first concern of the survey responders was the risk of surgical complications (92%). When asked about the respective importance of surgical safety, cure, and cosmetics, cure was placed first by 74%, safety by 33%, and cosmetics by 3%. These results were not influenced by sex, age, prior surgery or endoscopy, or education. When operative risk was similar, 90% of the participants preferred a scarless approach (75% preferred LESS and 15% preferred NOTES) to laparoscopy. The scarless approach preference was significantly higher among the younger participants (age<40 years; p=0.026), whereas sex showed no influence. The LESS preference was significantly higher among patients and the general population (86%) than among medical (67%) and paramedical (70%) staffs (p<0.001). A decreasing trend of preference for LESS and NOTES was observed with increased procedural risks.
  
  
  CONCLUSIONS
  Although cure and safety remain the main concern, the population has a favorable perception of scarless surgery, even in the case of increased procedural risk, with LESS favored over NOTES. Such a popular adoption of scarless surgery should warrant the promotion of further research, technological innovations, and the establishment of surgeon training to improve its safety.
authors.affiliation: Department of Surgery, Clinic of Visceral and Transplantation Surgery, University Hospital Geneva, 24 rue Micheli-du-Crest, 1211, Geneva, Switzerland. pascal.bucher@hcuge.ch
authors.forename: Pascal
authors.initials: P
authors.lastname: Bucher
authors.forename: François
authors.initials: F
authors.lastname: Pugin
authors.forename: Sandrine
authors.initials: S
authors.lastname: Ostermann
authors.forename: Frederic
authors.initials: F
authors.lastname: Ris
authors.forename: Michael
authors.initials: M
authors.lastname: Chilcott
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001828:Body Image; D002921:Cicatrix / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004954:Esthetics; D005260:Female; D005544:Forecasting; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods* / Q000639:trends; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000639:trends; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010465:Perception; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult