Small Bowel Injury During Laparoendoscopic Single-Site Surgery for Simple Nephrectomy

Background and Objectives:

A 71-year-old man underwent a right simple nephrectomy via the laparoendoscopic single-site surgery (LESS) approach for intractable right flank pain and gross hematuria. A postoperative diagnosis of duodenal injury was suspected by physical findings and confirmed by computed tomography imaging.

Methods:

Emergency exploratory laparotomy revealed a <5-mm full-thickness perforation of the duodenum and an accompanying 1-cm seromuscular injury.

Results:

The subsequent postoperative course was unremarkable except for a right intraabdominal seroma that resolved without intervention.

Conclusion:

LESS nephrectomy is an effective surgical approach, but more data are needed regarding its surgical outcomes and complications. This case shows that the LESS approach is not without the risk of life-threatening complications, and it must be performed by experienced surgeons in select patients who are notably interested in improved cosmesis, after an informed consent that includes the potential for complications.     

Feasibility and Acceptance of a Robotic Surgery Ergonomic Training Program

Background and Objectives:

Assessment of ergonomic strain during robotic surgery indicates there is a need for intervention. However, limited data exist detailing the feasibility and acceptance of ergonomic training (ET) for robotic surgeons. This prospective, observational pilot study evaluates the implementation of an evidence-based ET module.

Methods:

A two-part survey was conducted. The first survey assessed robotic strain using the Nordic Musculoskeletal Questionnaire (NMQ). Participants were given the option to participate in either an online or an in-person ET session. The ET was derived from Occupational Safety and Health Administration guidelines and developed by a human factors engineer experienced with health care ergonomics. After ET, a follow-up survey including the NMQ and an assessment of the ET were completed.

Results:

The survey was sent to 67 robotic surgeons. Forty-two (62.7%) responded, including 18 residents, 8 fellows, and 16 attending physicians. Forty-five percent experienced strain resulting from performing robotic surgery and 26.3% reported persistent strain. Only 16.6% of surgeons reported prior ET in robotic surgery. Thirty-five (78%) surgeons elected to have in-person ET, which was successfully arranged for 32 surgeons (91.4%). Thirty-seven surgeons (88.1%) completed the follow-up survey. All surgeons participating in the in-person ET found it helpful and felt formal ET should be standard, 88% changed their practice as a result of the training, and 74% of those reporting strain noticed a decrease after their ET.

Conclusion:

Thus, at a high-volume robotics center, evidence-based ET was easily implemented, well-received, changed some surgeons'' practice, and decreased self-reported strain related to robotic surgery.     

Adrenalectomy by Retroperitoneal Laparoendoscopic Single Site Surgery

Background:

Laparoscopic adrenalectomy is the current standard for treatment of benign adrenal disease. To reduce the invasiveness of surgery, new techniques have been recently proposed, such as mini-laparoscopy, natural orifice transluminal endoscopic surgery, and laparoendoscopic single site surgery (LESS). Herein, we describe one case of adrenalectomy by retroperitoneal LESS using conventional laparoscopic instruments and ports.

Case Report:

A 52-year-old female patient with an incidental finding of a 3-cm mass in the left adrenal was referred to us. Preoperative blood concentrations of catecholamines, aldosterone, and cortisol, and urinary excretion of vanilmandelic acid were normal. She underwent an adrenalectomy by retroperitoneal LESS using conventional instruments and ports. Operative time and estimated blood loss were 82 minutes and <50cc, respectively. She was discharged 12 hours after surgery. No intra- or postoperative complications occurred. Pathological analysis of the specimen identified an adrenal cortical adenoma.

Conclusion:

Adrenalectomy by retroperitoneal LESS using conventional laparoscopic instruments is feasible. Further studies must be performed to evaluate safety, indications and benefits of this approach.     

Laparoscopic single site adrenalectomy using a conventional laparoscope and instrumentation

Background and Objectives:

We present a case of Laparoendoscopic Single Site Surgery (LESS) left adrenalectomy performed with a conventional laparoscope and instruments.

Methods:

A 45-year-old male was diagnosed with hyperaldosteronism. Computed tomography detected a left adrenal nodule. Bilateral adrenal vein sampling was consistent with a left-sided source for hyperaldosteronism.

Results:

Total operative time for LESS left adrenalectomy was 120 minutes. The surgery was performed with conventional instruments, a standard 5-mm laparoscope, and a SILS port, with no additional incisions or trocars needed. No complications occurred, and the patient reported an uneventful recovery.

Conclusions:

LESS adrenalectomy is a feasible procedure. Although articulating instruments and laparoscopes may offer advantages, LESS adrenalectomy can be done without these.     

The Learning Curve of Laparoendoscopic Single-Site (LESS) Fundoplication: Definable,Short, and Safe

Background and Objectives:

This study of laparoendoscopic single-site (LESS) fundoplication for gastroesophageal reflux disease was undertaken to determine the “learning curve” for implementing LESS fundoplication.

Methods:

One hundred patients, 38% men, with a median age of 61 years and median body mass index of 26 kg/m², underwent LESS fundoplications. The operative times, placement of additional trocars, conversions to “open” operations, and complications were compared among patient quartiles to establish a learning curve. Median data are reported.

Results:

The median operative times and complications did not differ among 25-patient cohorts. Additional trocars were placed in 27% of patients, 67% of whom were in the first 25-patient cohort. Patients undergoing LESS fundoplication had a dramatic relief in the frequency and severity of all symptoms of reflux across all cohorts equally (P < .05), particularly for heartburn and regurgitation, without causing dysphagia.

Conclusion:

LESS fundoplication ameliorates symptoms of gastroesophageal reflux disease without apparent scarring. Notably, few operations required additional trocars after the first 25-patient cohort. Patient selection became more inclusive (eg, more “redo” fundoplications) with increasing experience, whereas operative times and complications remained relatively unchanged. The learning curve of LESS fundoplication is definable, short, and safe. We believe that patients will seek LESS fundoplication because of the efficacy and superior cosmetic outcomes; surgeons will need to meet this demand.     

Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery

Background

Laparoendoscopic single-site surgery (LESS) is reported to result in superior cosmesis versus alternative surgical approaches, based solely on surgeon assessment or anecdotal evidence.

Objective

Evaluate patient-reported body image and cosmesis outcomes following kidney surgery.

Design, setting, and participants

We conducted a prospective and retrospective observational cohort study involving patients who underwent kidney surgery (n = 114) via LESS (n = 35), laparoscopic (n = 52), or open (n = 27) approaches. Cosmesis was evaluated using a comprehensive survey administered ≥3 mo postoperatively.

Measurements

Survey components were a body image questionnaire (BIQ) consisting of body image and cosmesis subscales, a photo-series questionnaire (PSQ) assessing scar preferences after knowledge of scar outcomes for alternative surgical approaches, and query of preference for future surgical approach using a trade-off method. Body image, cosmesis, and PSQ scales ranged from 5 to 20, 3 to 24, and 1 to 10, respectively.

Results and limitations

Median BIQ component scores did not significantly differ across surgical approaches. Median ratings for the LESS, laparoscopy, and open scar photographs were 8, 5, and 5, respectively (p = 0.0001). Before viewing photographs, median self-scar ratings for LESS, laparoscopy, and open approaches were 9, 5, and 6.5, respectively (p = 0.02); after photographs, ratings were 9, 7, and 7, respectively (p = 0.008). Assuming equivalent surgical risk among the approaches, overall preference for future LESS, laparoscopy, or open surgery was 39%, 33%, or 4%, respectively. As theoretical risk of LESS was raised, preference for LESS decreased, whereas preference for laparoscopy and open surgery increased. Study limitations are a nonrandomized design and the use of a nonvalidated scale.

Conclusions

Urologic patients favor LESS cosmesis outcomes over those for laparoscopy or open surgery. Considering the superior scar satisfaction among LESS patients, who were younger and more likely to be undergoing surgery for benign disease, we infer that this demographic most values the cosmetic advantages of LESS.     

Open versus endovascular repair of abdominal aortic aneurysm: a survey of Canadian vascular surgeons

Objective

The aim of this survey was to determine Canadian vascular surgeons'' experience with elective endovascular aortic repair (EVAR) and traditional open repair and their interest in participating in an expertise-based randomized controlled trial (RCT) as opposed to a conventional RCT comparing these 2 procedures.

Methods

A single-page questionnaire was developed and sent by fax, email or post to all vascular surgeons in Canada. Nonresponders were recontacted on 2 additional occasions to improve the response rate. The questionnaire had 2 sections. The first inquired about current and past practice patterns, including experience in both open and endovascular techniques. The second investigated the surgeons'' belief in the value of open as opposed to endovascular repair and the value of expertise-based RCT methodology; it also canvassed their interest in participating in a future trial. Definitions of expertise in open and endovascular repair were drawn from the published literature. Criteria to determine the feasibility of conducting an expertise-based RCT were established a priori.

Results

The questionnaire was sent to 259 surgeons who appeared in multiple vascular surgery databases, and the overall response rate was 56% (95% confidence interval [CI] 50%–62%). The mean career experience was 406 cases (standard deviation [SD] 359) for conventional open abdominal aortic aneurysm (AAA) repair and 24 cases (SD 48) for endovascular repair. Of the responding surgeons, 51% (95% CI 41%–60%) ranked conventional open repair as “probably superior.” Respondents were equally interested in participating in an RCT using either expertise-based methodology (54%, 95% CI 44%–63%) or conventional design (51%, 95% CI 41%–60%).

Conclusion

Uncertainty exists among vascular surgeons in Canada as to the role of endovascular surgery in the repair of AAA. A national RCT comparing open with endovascular repair in the elective setting is potentially feasible with either expertise-based or conventional design. Increases in the number of surgeons who are willing to participate and have expertise in EVAR, in addition to high recruitment rates among eligible patients, will be necessary to make such a trial feasible in Canada.     

Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery

Background and Objectives:

Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined.

Methods:

All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months'' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh.

Results:

A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months'' follow-up.

Conclusion:

Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.     

Percutaneous Ureteral Elevation in Laparoendoscopic Single-Site Radical Nephrectomy

Background and Objectives:

To describe our technique of suture-assisted ureteral retraction during Laparoendoscopic Single-Site (LESS) radical nephrectomy.

Materials and Methods:

A healthy, 39-year-old woman with an incidental 5-cm enhancing left renal mass elected to undergo radical nephrectomy. A 2-cm skin incision was made in the left upper quadrant of the abdomen, and a Covidien SILS port was introduced using standard Hasson techniques. Straight and angled laparoscopic instruments were used to mobilize the kidney outside of Gerota''s fascia. To place the renal vessels on stretch and facilitate hilar dissection, the ureter and lower pole attachments were encircled with a 0-Vicryl suture inserted percutaneously via a disposable fascial closure device. The kidney was bagged and removed intact.

Results:

The procedure was performed without complication with a total operative time of 265 minutes. EBL was minimal at 25mL. The patient was discharged home on postoperative day 1, and final pathology revealed stage pT1b chromophobe renal cell carcinoma with negative surgical margins.

Conclusion:

LESS radical nephrectomy is feasible in select patients. Suture-assisted retraction of the ureter and lower pole attachments using a fascial closure device facilitates safe dissection and control of the renal hilum.     

Upper Tract Urological Laparoendoscopic Single-Site Surgery (LESS)

Background and Objectives:

Our objective is to report intermediate-term outcomes for patients who have undergone upper tract urologic laparoendoscopic single-site surgery (LESS) at a single institution.

Methods:

From January 1, 2008, through November 30, 2012, 107 cases treated with LESS were identified, including pyeloplasty (n = 30), ureterolithotomy (n = 32), nephrectomy (n = 35; simple = 31, partial = 4), and cyst decortication (n = 10). Perioperative data were reviewed, and conversion and complication rates were noted.

Results:

The median follow-up was 21.5 months for pyeloplasty, 20.5 for ureterolithotomy, 28.0 for simple nephrectomy, 14.0 for partial nephrectomy, and 19.0 for cyst decortication. Major complications were encountered in 8 patients, including 3 intraoperative complications (2 bowel injury with serosal tearing and 1 intraoperative bleeding), which were recognized and repaired with LESS or conversion to conventional laparoscopy (CL). During the intermediate postoperative period (30–90 days) major complications occurred in 5 patients: 4 ureteral strictures (Clavien-Dindo grade [CG] IIIb) and 1 urinoma formation (CG IIIa). During the early postoperative period (<30 days), the most common minor complications were flank pain (CG I) in 16 patients and urinary tract infection (CG II) in 11, followed by urinary leakage (CG I) in 8.

Conclusions:

Intermediate-term functional outcomes of this single-center study confirm that upper tract LESS is a challenging procedure that can be safe and effective when performed by an experienced team. Prospective studies with longer follow-up periods are needed to investigate the safety of LESS in the treatment of various upper urinary tract conditions.     

Laparoendoscopic single site (LESS) splenectomy with a conventional laparoscope and instruments

Background and Objectives:

We present 2 cases of laparoendoscopic single site surgery (LESS) splenectomy performed with a conventional laparoscope and instruments, and the use of a novel internal retraction device.

Methods:

One patient underwent LESS splenectomy for idiopathic thrombocytopenia purpura (ITP), and a pediatric patient with sickle cell disease underwent LESS splenectomy and cholecystectomy. In each case, a 2-cm vertical incision was made within the confines of the umbilical ring, and a SILS port (Covidien, Norwalk CT) inserted. A 5-mm, 30-degree laparoscope and standard 5-mm instruments were used. After isolation of the splenic hilum, one 5-mm trocar of the SILS port was upsized to 12mm, and a laparoscopic stapler was used to divide the splenic artery and vein. An internal retractor consisting of a laparoscopic bulldog clamp with a hook attachment was used to retract the gallbladder, and to secure the specimen retrieval bag during splenic extraction, which eliminated the need for a fourth trocar.

Results:

Total operative time was 160 minutes for the LESS splenectomy, and 216 minutes for the LESS splenectomy and cholecystectomy. Both procedures were successfully completed with conventional instrumentation and a SILS port, without the need for additional incisions or trocars. No complications occurred, and both patients had an uneventful recovery.

Conclusions:

LESS splenectomy is a feasible procedure that can be performed safely. Although articulating instruments and laparoscopes may offer advantages, they are not necessary for performing LESS splenectomy.     

Development of a Measurement System for Laparoendoscopic Single-Site Surgery: Reliability and Repeatability of Digital Image Correlation for Measurement of Surface Deformations in SILS Port

Objective:

Analysis of mechanical measurements in laparoendoscopic single-site surgery (LESS) is important for instrument design and surgical simulators. The aim of this study was to develop a measuring system for different instruments and manipulations in LESS using a single-incision laparoscopic surgery (SILS) port.

Methods:

The loads on the SILS port were applied and recorded by the universal material testing machine by the following method. The handle of the forceps inserted in the SILS port was connected with the machine by a fishing wire and pulled at a constant rate. The surface deformations (displacements and strains) of the SILS port were recorded with digital image correlation (DIC) simultaneously. The correlation between deformation measurements and loads were analyzed. This experiment was repeated 8 times.

Results:

Strong correlations existed between deformation measurements calculated by DIC and objective criteria “loads” applied and recorded by the universal material testing machine (r > 0.98). The correlation coefficients were statistically significant (P < .001). A high repeatability of the results appeared in all repetitions of the experiment.

Conclusions:

A DIC measurement system has been developed for LESS, and comprehensive mechanical parameters of a SILS port can be obtained precisely by using this system. It is reliable and repeatable for evaluation of instruments and manipulations in LESS.     

Atypical as well as anatomical liver resections are feasible by laparoendoscopic single-site surgery

INTRODUCTION

Liver surgery was one of the last fields to be conquered by laparoscopy, which has become safe and effective, especially for left lateral sectionectomy (LLS) and limited peripheral resections. However, major hepatectomies remain challenging. Laparoendoscopic single-site (LESS) surgery is being employed for an increasing variety of surgical sites and indications.

PRESENTATION OF CASE

Three patients underwent LESS hepatectomy. A 36-year-old woman had LLS for a 38-mm adenoma, an 85-year-old woman an atypical resection of segment VI for a 12-mm hepatocellular carcinoma and a 41-year-old woman an atypical right anterior resection for a 9 cm symptomatic FNH. Procedures were performed transperitoneally with a single-port device, via a 20-mm or 30-mm incision. Operative times were 110 min for LLS, 100 min for the atypical segment VI resection and 120 min for the atypical right anterior liver resection. Blood loss was less than 50 ml in the first two patients and 150 ml in the third. Postoperative courses were uneventful. The first two patients were discharged on postoperative day 3 and the third on postoperative day 1.

DISCUSSION

To date, some case reports and series of LESS liver surgery have been published. We performed the reported hepatectomies after a considerable experience in laparoscopic hepatic surgery and after applying the LESS approach to other procedures. Our hepatectomy technique was not modified by the use of the single-port and results were very encouraging.

CONCLUSION

We believe that in selected patients, both peripheral resections and LLS are feasible by LESS surgery, with good intra-operative and post-operative results.     

Transitioning to Single-Incision Laparoscopic Inguinal Herniorrhaphy

Background:

Laparoendoscopic single-site surgery (LESS) offers cosmetic benefits and may represent further progress towards reducing the invasiveness of surgical interventions. We report our initial experience with LESS totally extraperitoneal (TEP) inguinal herniorrhaphy.

Materials and Methods:

Beginning March 2009, we transitioned from a multiport laparoscopic TEP (MLH) technique to a single-incision TEP (SITE) technique. The first 52 consecutive patients who underwent SITE at our institution were compared with the preceding 52 MLH repairs.

Results:

Of the first 52 patients undergoing SITE, there were no conversions to either open or multiport surgery. The mean operative time for the SITE cases did not differ significantly from that of MLH. Complications were equivalent between the 2 groups and included postoperative seroma and urinary retention.

Conclusions:

Transitioning from MLH to SITE was readily accomplished without significantly altering operative time or morbidity.     

Hand surgery after axillary lymph node clearance for breast cancer: contra-indication to surgery?

INTRODUCTION

Breast cancer patients who have had prior axillary lymph node clearance (ALNC) can present with ipsi lateral hand conditions that could easily be treated with surgical intervention. These patients are often advised to avoid interventional procedures due to risks of complications such as lymphoedema, infection and cellulitis.

SUBJECTS AND METHODS

Between April and June 2009, we conducted an online survey of hand surgeons, breast surgeons and breast-care nurses to obtain their views on hand surgery after ipsilateral axillary lymph node clearance.

RESULTS

The majority of hand surgeons (58%) felt there was no contra-indication to surgery in a breast cancer patient with prior ipsilateral ALNC compared to just 30% of breast surgeons and 10% of breast-care nurses. The majority of breast surgeons and breast-care nurses (70% and 89%, respectively) felt that hand surgery was a relative contra-indication compared to just 41% of hand surgeons. Postoperative lymphoedema was the commonest cited reason for avoiding surgery. The majority of hand surgeons (79%) and nearly two-thirds of breast surgeons (57%) would use a tourniquet during surgery if it was normal practice.

CONCLUSIONS

A review of the published literature does not support the notion that these patients experience increased complications; therefore, we recommend the advice given to breast cancer patients regarding ipsilateral surgery be re-evaluated.     

A Reproducible Ex Vivo Model for Transanal Minimally Invasive Surgery

Background:

Rectal tumors can be excised through a number of minimally invasive transanal techniques including transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery (TAMIS). Specialty training is often required to master the nuances of these approaches. This study aimed to create a reproducible transanal excision training model that is suited for laparoendoscopic techniques.

Methods:

Frozen porcine rectum and anus with intact perianal skin were commercially obtained. Thawed specimens were then cut to approximately 20 cm in length. The proximal end of the rectum was then everted and suction applied to the mucosa to create pseudopolyps of various sizes (sessile and pedunculated). Larger pedunculated lesions were made by tying the base of the pseudopolyps with 5–0 monofilament sutures to gather more tissue. Methylene blue dye was injected submucosally into the lesions to simulate tattoos. The proximal rectum was then closed with sutures. The model was suspended in a trainer box by clamping the distal end in a ringed clamp and the proximal end to the box. Transanal excisions using TAMIS were then performed. The procedures were done by trained community colorectal surgeons attending courses on transanal minimally invasive surgery.

Results:

Both partial- and full-thickness excisions of sessile and pedunculated rectal lesions were successfully performed during simulated TAMIS by trained community surgeons learning this laparoendoscopic technique.

Conclusion:

Transanal laparoendoscopic procedures to excise rectal tumors can be successfully and reproducibly performed in an ex vivo porcine anorectal model.     

Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons

BACKGROUND:

Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada.

METHODS:

An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery.

RESULTS:

The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements.

CONCLUSIONS:

The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.     

Current practice in abdominoperineal resection: an email survey of the membership of the Association of Coloproctology

INTRODUCTION

This study aimed to gain insight into current preferences for type of surgical approach and patient positioning in abdominoperineal excision of the rectum (APER), to identify whether these factors affect self-reported oncological outcomes and complication rates, and to assess the opinions of members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) with regards to the benefit of a national training programme for APER surgery.

METHODS

Members of the ACPGBI were surveyed using a questionnaire designed to examine surgeon/departmental demographics, type of APER practised, audit of results and complications, opinions regarding extralevator APER (ELAPER) and opinions regarding the potential benefit of a national training programme.

RESULTS

According to the survey, 62% of surgeons perform perineal dissection in the supine position and 57% perform a standard APER technique. Surgeons who only practise colorectal surgery (p=0.002) and surgeons performing prone dissection (/xO.0001) are more likely to perform ELAPER. Three-quarters (76%) audit their results for perineal wound complication rates. Over 80% audit their oncological outcomes. The vast majority (94.6%) of those who perform ELAPER believe there is a benefit to this method while 59.6% of those who do not perform ELAPER still believe there is a benefit to ELAPER. Only 50% feel that there should be a national training programme.

CONCLUSIONS

There is a distinct discordance with regards to the APER technique. Among UK colorectal surgeons, although a significant proportion favours ELAPER, there remains a larger proportion still performing standard APER techniques.     

Practice profiles in breast reduction: A survey among Canadian plastic surgeons

BACKGROUND:

Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons.

OBJECTIVE:

The goal of the present study was to assess trends in breast reduction surgery among Canadian surgeons, including patient selection criteria, surgical techniques and outcomes.

METHOD:

Surveys were distributed to plastic surgeons at the Canadian Society for Plastic Surgery meetings in 2005 and 2006. Completed surveys were obtained from 140 respondents, and results were analyzed with Excel and SAS software.

RESULTS:

There was a 40% response rate. The majority of surgeons (66%) used more than one technique for breast reduction. Most commonly, surgeons use the inverted T scar technique (66%) followed by vertical scar techniques (26%). The most popular vertical scar techniques included the Hall-Findlay (14%) and Lejour (13%) methods. Most surgeons (55%) reported complication rates of less than 5% and the most common complication reported was wound dehiscence. There was no difference in overall complication rates between inverted T scar and vertical scar surgeries. The majority of surgeons (98%) carried out breast reduction either exclusively as day surgery or in combination with same-day admission. Breast reduction performed as day surgery resulted in cost savings of $873 per patient.

CONCLUSIONS:

Canadian plastic surgeons are performing more vertical scar breast reductions than American surgeons. However, both groups rely predominantly on inverted T scar techniques.