title: Patient scar assessment after single-incision versus four-port laparoscopic cholecystectomy: long-term follow-up from a prospective randomized trial.
abstract: BACKGROUND
  The single-incision laparoscopic approach for cholecystectomy has been reported to be cosmetically superior in the traditional four-port technique in several case series; however, prospective comparative data are lacking. We conducted a 60-patient, prospective, randomized trial comparing single-incision laparoscopic cholecystectomy with standard four-port cholecystectomy, including validated scar assessment evaluation around 6 weeks and 18 months after the operation in an effort to determine if a cosmetic advantage existed.
  
  
  METHODS
  Patients over 12 years of age and parents of patients under 12 years of age enrolled in the trial were asked to complete the validated Patient Scar Assessment Questionnaire (PSAQ). The PSAQ consists of four subscales: Appearance, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms. The Symptoms subscale is omitted from analysis per PSAQ instructions because of insufficient reliability. Each subscale is a set of items with 4-point categorical responses (from 1=most favorable to 4=least favorable). The sum of the questions quantifies each subscale. Data are expressed as mean±standard deviation values.
  
  
  RESULTS
  Eighteen single-site patients and 8 four-port patients completed early questionnaires, in which there was no difference in overall scar assessment (P=.17). Telephone follow-up was accomplished for 17 single-site patients and 24 four-port patients and revealed that the overall scar assessment significantly favored the single-site approach (P=.04).
  
  
  CONCLUSIONS
  Patients or parents of patients do not identify an overall superior scar assessment at early follow-up after single-site laparoscopic versus four-port cholecystectomy. However, they do perceive a superior scar assessment at long-term follow-up, suggesting that there is a cosmetic benefit favoring the single-site approach.
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI 53792, USA. ostlie@surgery.wisc.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Sharp
authors.forename: Priscilla
authors.initials: P
authors.lastname: Thomas
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000175:diagnosis* / Q000209:etiology; D059026:Diagnostic Self Evaluation; D005500:Follow-Up Studies; D006801:Humans; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors