title: Asian-Chinese patient perceptions of natural orifice transluminal endoscopic surgery cholecystectomy.
abstract: OBJECTIVE
  Patient and physician perceptions of natural orifice transluminal endoscopic surgery (NOTES) have been reported for the Western population. However, whether Asian-Chinese patients share the same perspectives as compared to the Western population is unknown.
  
  
  METHODS
  This was a cross-sectional survey carried out in the surgical outpatient's clinic at the Prince of Wales Hospital between June and September 2011. Patients were provided with an information leaflet and asked to complete a questionnaire regarding their perceptions of and preferences for NOTES cholecystectomy. Female patients attending the clinic were given an additional questionnaire regarding attitudes towards transvaginal surgery.
  
  
  RESULTS
  Two hundred patients were recruited to complete the questionnaire(s) and the male to female ratio was 1:1. One hundred and fourteen patients (57%) preferred to undergo NOTES cholecystectomy for cosmetic reasons (P=0.009). Oral and anal routes were both acceptable for NOTES accesses in males and females. Forty-one percent of the female patients would consider transvaginal NOTES. Of these patients, significantly more patients indicated that the reason for choosing transvaginal NOTES was to minimize the risk of hernia (P=0.016) and to reduce pain associated with the procedure (P=0.017). The risk of complications (84.5%) and the cost of the procedure (58%) were considered the most important aspects when choosing a surgical approach by Asian-Chinese patients.
  
  
  CONCLUSIONS
  Asian-Chinese preferred NOTES mainly for cosmetic reasons. However, the transvaginal route was less acceptable to females. Significant differences in patient perception on NOTES were observed between Asian-Chinese and Western patients.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
authors.forename: Alana
authors.initials: A
authors.lastname: Chock
authors.forename: Lee
authors.initials: L
authors.lastname: Swanstrom
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000367:Age Factors; D044466:Asian People / Q000706:statistics & numerical data*; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002921:Cicatrix / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D057240:Patient Preference / Q000208:ethnology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*; D012007:Rectum; D011795:Surveys and Questionnaires; D014621:Vagina
keywords: natural orifice transluminal endoscopic surgery (NOTES); patient perception; transgastric surgery; transluminal access; transvaginal surgery