M.A. Varsanik1, M. Fefferman1, C. Zheng1, Y. Vigneswaran1 1University of Chicago, General Surgery, Chicago, IL, USA
Introduction: Surgical scars may affect patients' quality of life, mental health and overall well-being. Minimally invasive surgery (MIS) offers faster healing and improved scar cosmesis, with a particular benefit for patients prone to keloids or hypertrophic scarring. Few studies discuss cosmetically favorable options for robotic port site selection, and assessment for patient preference for port site location is lacking. We hypothesized that patients prefer incisions placed low on the abdomen (bikini line or pubic hairline) to traditionally placed incisions (central abdomen) for general surgery MIS procedures.
Methods: This retrospective survey study was conducted at a single institution including patients who visited the MIS clinic between Jan 2022-Jan 2024. The SCAR-Q validated survey assessed patient perspectives of scar appearance and psychosocial impact. A second survey asked about patient preference for incision placement and asked patients to rate their opinions about surgical scars on a scale of 0-5.
Results: 58 male and 123 female patients responded; 33 were black, 78 white, and 13 other. Overall, 58% preferred bikini line incisions, while 17% chose traditional laparoscopic placement, and 25% chose traditional robotic port site placement (Fig 1A). Females and younger patients (<50 years old) had higher psychosocial scar scores compared to males (p=0.004) and older patients (p=0.036). Females preferred their incisions to be hidden compared to males (p<0.001). Black patients had higher appearance (p=0.007) and psychosocial (p=0.010) scar scores compared to white patients. Nevertheless most patients prioritized the safety of their surgery over the visibility of their incisions. When prompted to choose any 4 incisions (Fig 1B), 40% chose bikini line incisions (MNOP), 6.8% chose traditional robotic incisions (IJKL), and the remainder chose other combinations (EHMN, ILMN, JKOP) that are low / on the periphery of the abdomen.
Conclusion: This survey study reflects a preference among patients for lower abdominal (bikini line or pubic hairline) incisions over traditional laparoscopic or robotic port site incisions routinely used in MIS. These preferences are notable among females, black patients and younger patients who exhibit higher psychosocial impact scores related to scar visibility. Patients' selection of incisions on the inferior / periphery of the abdomen may suggest a partiality of hidden scar placement. These findings identified an opportunity for personalized and safe surgical planning that considers patient preferences and demographic factors to improve patient satisfaction in MIS procedures. Further research is necessary to explore the long-term benefits and implications of optimizing incision placement.