title: Skin closure methods after single port laparoscopic surgery: a randomized clinical trial.
abstract: OBJECTIVE
  To compare postoperative cosmetic outcomes according to different umbilical closure methods after single port laparoscopic surgery (SP-LS).
  
  
  METHODS
  A total of 138 women who were scheduled to receive elective SP-LS were randomized to undergo closure of the umbilical incision with either a subcutaneous suture only without subcuticular skin suture (case group, n=68) or both a subcutaneous suture and subcuticular skin suture (control group, n=70) after fascial closure. At postoperative months 1 and 3, the umbilical scar was evaluated using the Vancouver scar scale (VSS), the patient and observer scar assessment scale, and a visual analog scale (VAS). Overall satisfaction with scar cosmesis and surgery was assessed with the VAS.
  
  
  RESULTS
  There was no significant difference in the clinical characteristics and operative data between the groups. The objective and subjective scar assessments and the overall satisfaction with scar cosmesis were not different between the groups. In the control group, four (5.7%) women experienced wound discharge and were treated with conservative treatments and delayed closure. In women who completed the first and second assessments, the changes in the scar assessment and overall satisfaction with the scar according to time after surgery were not different in either group, but the patient scar assessment scale in both groups and the VSS in the case group improved.
  
  
  CONCLUSIONS
  After SP-LS, the approximation of the fascia and subcutaneous layer seems to be enough for the closure of an umbilical incision. Skin closure with subcuticular sutures did not improve the postoperative cosmetic outcomes and might lead to impaired wound healing. However, large randomized trials with various closure techniques and materials are needed to confirm this finding.
authors.affiliation: The Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Seoul, Republic of Korea.
authors.forename: Sue Yeon
authors.initials: SY
authors.lastname: Park
authors.affiliation: The Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kye Hyun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: The Department of Obstetrics and Gynecology, MizMedi Hospital, Eulji University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Sung
authors.initials: JS
authors.lastname: Yuk
authors.affiliation: The Department of Obstetrics and Gynecology, MizMedi Hospital, Eulji University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Ji
authors.affiliation: The Department of Obstetrics and Gynecology, MizMedi Hospital, Eulji University School of Medicine, Seoul, Republic of Korea. Electronic address: leemjjm@gmail.com.
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000473:pathology; D062109:Dermatologic Surgical Procedures; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D013536:Suture Techniques; D013537:Sutures; D014472:Umbilicus / Q000473:pathology; D058106:Wound Closure Techniques
keywords: Cosmesis; Laparoscopy; Scar assessment scale; Single port surgery