title: Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery.
abstract: Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? Studies in other surgical populations have found that scarring is a relatively unimportant preoperative patient consideration when compared with surgical cure and safety, but that younger age was a significant factor influencing preference for 'scarless' surgery. The present study corroborates the findings of previous series, among patients who were contemplating kidney surgery.
  
  
  OBJECTIVE
  • To evaluate patient attitudes towards cosmesis relative to other considerations, before and after undergoing laparoendoscopic single-site surgery (LESS) vs laparoscopic/robot-assisted vs open kidney surgery.
  
  
  METHODS
  • Participants were provided with a survey querying demographic information, surgical history and importance of scarring relative to other surgical outcomes and considerations. • The relative importance of each outcome was recorded on a nine-level ranking scale, ranging from 1 (most important) to 9 (least important). • The median scores for each outcome were compared before and after surgery using the Wilcoxon signed-rank test, and by surgical approach using the Kruskal-Wallis test. • The importance of scarring was further analysed according to age (≤ 50 vs >50 years), surgical indication (oncological vs non-oncological), gender, and proportion of patients who had undergone previous abdominal surgery.
  
  
  RESULTS
  • A total of 90 patients completed surveys before surgery, of whom 65 (72.2%) also completed surveys after surgery. • 'Surgeon reputation' and 'no complications' were the most important considerations before surgery (median scores 2 and 3, respectively) and after surgery (median scores of 2 for both). • 'Size/number of scars' was the least important consideration before surgery (median score 8) and the second least important consideration after surgery (median score 7). • The median score for 'size/number of scars' was significantly higher for the LESS cohort before surgery (laparoscopic/robot-assisted vs LESS vs open surgery: 8.5 vs 6 vs 9; P = 0.003), but was nonsignificant after surgery (laparoscopic/robotic vs LESS vs open surgery: 7 vs 6.5 vs 7.5; P = 0.83). • The median score for 'size/number of scars' before surgery was significantly higher for younger patients (P = 0.05) and those with non-oncological surgical indications (P < 0.001), but there was no significant difference in this outcome for these sub-groups after surgery.
  
  
  CONCLUSIONS
  • For most patients contemplating urological surgery, cosmesis is of less concern than surgeon reputation and avoidance of surgical complications. • Cosmesis may be a more important preoperative consideration for younger patients and those with benign conditions, which warrants further investigation.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
authors.forename: Ephrem O
authors.initials: EO
authors.lastname: Olweny
authors.forename: Saad A
authors.initials: SA
authors.lastname: Mir
authors.forename: Sara L
authors.initials: SL
authors.lastname: Best
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Park
authors.forename: Chester
authors.initials: C
authors.lastname: Donnally Iii
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: Chad R
authors.initials: CR
authors.lastname: Tracy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002921:Cicatrix / Q000523:psychology*; D002983:Clinical Competence / Q000592:standards; D004724:Endoscopy / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000523:psychology; D007674:Kidney Diseases / Q000523:psychology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods / Q000523:psychology; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D012371:Robotics / Q000379:methods; D014572:Urology / Q000592:standards