Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery

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.