title: Consumer demand for surgical innovation: a systematic review of public perception of NOTES.
abstract: BACKGROUND
  The full scope of benefits offered by NOTES over traditional laparoscopy, if any, is not yet fully clear. Perceived patient demand for truly "scarless surgery" is often referenced one of the driving factors in the continued development of this relatively new technique. The true scale of patient preference and demand for NOTES as a surgical technique is unknown. This review aims to summarise currently available literature on the topic of patient perceptions of NOTES to guide future development of the technique.
  
  
  METHODS
  A comprehensive search of PubMed and Web of Science electronic databases was performed on 1st Jan 2014. To be considered for inclusion, articles were required to assess and report the perception of NOTES in a sample of laypersons (patients or general public). The primary endpoint assessed was acceptance or preference rates expressed by patients for NOTES procedures. Reasons given for preference or rejection of NOTES were recorded, as well as preferred access routes and any predicting factors of NOTES acceptance.
  
  
  RESULTS
  Initial search returned 1,334 results, resulting in 15 articles included in final data synthesis. These polled a total of 4,420 subjects. Acceptance of NOTES ranged between 41 and 84 %. Compared to a laparoscopic approach, preference rates for NOTES ranged from 0 to 78 %. Reasons for preferring NOTES were largely centred on potentially reduced recovery time, complications (particularly with reference to hernias) and postoperative pain. Improved cosmesis also played a role, but was secondary to the above issues. Overall, study quality was poor.
  
  
  CONCLUSIONS
  This review suggests significant public interest in NOTES and scarless surgery in general. Further research and consideration of differences in public perceptions across regions, countries and cultures are required.
authors.affiliation: Department of Surgery, St Mary's Hospital, Imperial College London, London, W2 1NY, UK.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.forename: Mikael H
authors.initials: MH
authors.lastname: Sodergren
authors.forename: Amy C
authors.initials: AC
authors.lastname: Lord
authors.forename: Julian
authors.initials: J
authors.lastname: Teare
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D006301:Health Services Needs and Demand; D006801:Humans; D010535:Laparoscopy; D057605:Natural Orifice Endoscopic Surgery; D057240:Patient Preference