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Does Incision Location Matter? Analysis of Single-Port Cosmesis in Urologic Reconstructive Surgery.

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Single-port (SP) robotic surgery, particularly with umbilical incisions, offers superior cosmetic outcomes compared to multiport (MP) surgery. Younger patients (<40) benefit most from SP umbilical approaches for urinary reconstruction.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • Single-port (SP) robotic surgery may offer improved cosmesis over multiport (MP) robotic surgery.
  • Previous studies in urology did not specifically assess cosmetic differences based on SP incision location.
  • Understanding cosmetic outcomes is crucial for patient satisfaction in reconstructive procedures.

Purpose of the Study:

  • To evaluate single-port (SP) versus multiport (MP) robotic surgery for cosmetic outcomes and scar consciousness.
  • To assess the impact of incision location, age, gender, and prior abdominal surgery on cosmesis.
  • To identify predictors of patient satisfaction with surgical scars in genitourinary reconstruction.

Main Methods:

  • A cohort study utilizing a prospective genitourinary reconstruction database.
  • Patients completed the Patient Scar Assessment Questionnaire (Consciousness subsection) at least 3 months post-surgery.
  • Statistical analyses included chi-squared, Wilcoxon rank sum, Fisher's exact test, and logistic regression.

Main Results:

  • Of 111 patients (57 SP, 54 MP), SP umbilical incisions showed the lowest scar consciousness.
  • SP umbilical incisions were significantly less likely to be bothersome compared to MP incisions (OR=0.08, p=0.005).
  • Younger age was associated with higher scar bother and consciousness (p=0.012 and p=0.002, respectively).

Conclusions:

  • Single-port (SP) periumbilical incisions yield the best cosmetic results compared to other SP sites and MP incisions.
  • SP umbilical approaches should be considered for urinary reconstruction, especially for patients under 40.
  • Incision site selection is a key factor in optimizing cosmesis for robotic reconstructive surgery.