title: Choosing the cosmetically superior laparoscopic access to the abdomen: the importance of the umbilicus.
abstract: BACKGROUND
  Single-incision laparoscopy (SIL) is a rapidly growing procedure in the field of surgery. The most frequent site of abdominal access is the umbilicus. Its appearance can be altered during SIL procedures. The literature suggests that the umbilicus plays an important role in the overall physical appearance of patients. This study therefore investigated the perception of the general population regarding the cosmetics of the umbilicus.
  
  
  METHODS
  An online survey with 10 questions about the aesthetic importance of the umbilicus was circulated worldwide in both the English and French languages. All the answers then were gathered and analyzed.
  
  
  RESULTS
  The majority of the participants considered both their umbilicus and that of their partner as "unimportant." The total loss of their umbilicus and any undesired changes in its size, shape, and skin color were considered disturbing by most participants, but not its depth. In this survey, 39% of the women and 29% of the men agreed on a negative impact of an undesired change in their umbilicus, whereas 19% of the women and 36% of the men agreed on a negative impact of such a change in the umbilicus of their partner. The majority of the participants did not consider the umbilicus as playing a major role in sexual attractiveness.
  
  
  CONCLUSIONS
  The majority of the participants gave a limited cosmetic role to the umbilicus and would therefore be good candidates for an umbilical surgical access. Among the minority of participants who considered the umbilicus to be cosmetically important, the men tended to be more concerned about the aesthetic aspect of their partner's umbilicus, and a one-third of them agreed on its role in sexual appeal. Although not the majority, a significant proportion of participants were sensitive about the aspect of their umbilicus. Special care should be given to identify this population and choose the appropriate minimally invasive access.
authors.affiliation: Division of Digestive Surgery, University Hospital Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. pouya.iranmanesh@hcuge.ch
authors.forename: Pouya
authors.initials: P
authors.lastname: Iranmanesh
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Ihsan
authors.initials: I
authors.lastname: Inan
authors.forename: Monika
authors.initials: M
authors.lastname: Hagen
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001504:Beauty; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014472:Umbilicus; D055815:Young Adult