Yi Sang Wook
Division of Minimally Invasive Surgery and Gynecological Laparoendoscopy, Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Korea.
JSLS. 2019 Oct-Dec;23(4). doi: 10.4293/JSLS.2019.00050.
Laparoendoscopic single site surgery (LESS), a minimally invasive procedure, is performed in many hospitals. Although its cosmetic superiority is widely touted, some authors have disputed this view. Here, we compare the surgical and long-term cosmetic outcomes of and patient satisfaction with postoperative wounds for LESS and over 2-port laparoscopy (OTPL), including 2-port laparoscopy (TPL) and standard laparoscopy (SL), after a 6-mo follow-up period.
A total of 125 patients who underwent adnexal surgery performed by the same surgeon at the same institution between March 2005 and May 2017 were included. The patients were divided into 2 groups: the LESS group and the OTPL group. The patients completed an evaluation using the Patient Scar Assessment Scale (PSAS, used to evaluate linear scars) and the Ultimate Question (UQ, used to determine overall patient satisfaction). We evaluated surgical scars using the Observer Scar Assessment Scale, which includes the Umbilical Scar Overall Shape Assessment Scale (USOSAS) and the Vancouver Scar Scale (VSS).
There were no significant differences in the PSAS, UQ, USOSAS, and VSS results between the study groups. The USOSAS score was consistently correlated with VSS scores of 2, 3, and 4 and the total VSS score, indicating that the USOSAS score may be as effective as the VSS score.
Because the long-term patient satisfaction with and cosmetic wound outcomes of LESS were not significantly different from those achieved by OTPL, surgeons should consider performing LESS after weighing the pros and cons with regard to the patient's condition.
经脐单孔腹腔镜手术(LESS)是一种微创手术,已在多家医院开展。尽管其美容优势被广泛宣扬,但一些作者对此观点提出了质疑。在此,我们比较了LESS与两孔及以上腹腔镜手术(OTPL,包括两孔腹腔镜手术(TPL)和标准腹腔镜手术(SL))在术后6个月随访期后的手术及长期美容效果以及患者对术后伤口的满意度。
纳入2005年3月至2017年5月在同一机构由同一位外科医生进行附件手术的125例患者。患者分为两组:LESS组和OTPL组。患者使用患者瘢痕评估量表(PSAS,用于评估线性瘢痕)和终极问题(UQ,用于确定患者总体满意度)完成评估。我们使用观察者瘢痕评估量表评估手术瘢痕,该量表包括脐部瘢痕整体形状评估量表(USOSAS)和温哥华瘢痕量表(VSS)。
研究组之间在PSAS、UQ、USOSAS和VSS结果方面无显著差异。USOSAS评分与VSS的2、3、4分及VSS总分始终相关,表明USOSAS评分可能与VSS评分同样有效。
由于LESS患者的长期满意度和美容伤口效果与OTPL无显著差异,外科医生在根据患者病情权衡利弊后应考虑进行LESS手术。