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

Abstract

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.