Patient Preferences of Incision for Gynecologic Surgery

INTRODUCTION: Gynecologic surgeons are trained to use several different approaches for abdominal surgery. Patients frequently undergo gynecological surgery for various indications, including endometriosis, leiomyomas, ovarian cysts or masses, and pelvic inflammatory disease. This purpose of this prospective, double-blinded study was to determine which incision type patients would prefer for their gynecological surgeries, and why they prefer certain incisions over others. OBJECTIVE: To determine the most desired incisions by patients eligible for gynecologic surgery. To understand why patients desire one or more incision types over another. The null hypothesis was that there would be no difference in patient preference of incision type. METHODS: Patients attending a private reproductive endocrinology and infertility clinic were provided photographs of various abdominal incisions (n=113). These included Pfannenstiel (A), robotic-assisted laparoscopy (B), traditional laparoscopy incisions (C), mini-laparotomy (D), lower vertical (E), and single-site laparoscopy (F) (Figure 1). Women were also given multiple-choice explanations or could write in their explanations for why they preferred certain incisions over others. Categorical data were analyzed using descriptive statistics for frequencies and chi-square analysis to determine significant differences. This study was approved by the IRB at Baptist Hospital. RESULTS: The majority of patients (46%; n=52) preferred the mini-laparotomy incision (Table 1). The single-site laparoscopy incision was also highly preferred by patients, with 26.5% (n=30) of patients choosing that as their most preferred incision type. The least preferred incision was the vertical midline incision (49.6%; n=56). Robotic Incisions were the second least preferred incision type, with 24.8% (n=28) of patients choosing this option. The preference for the single mini-laparotomy incision compared to the multiple robotic incisions was highly significant (p< 0.05). Patients reported that they chose their answer because it was the smallest incision type (76%; n=85), that it involved the fewest number of incisions (54%; n=61), and because it was most easily concealable by clothing (40%; n=45). Patients were given the option to select more than one choice for their reasoning. CONCLUSIONS: Patients in our study preferred fewer, more concealed, and smaller incisions. The mini-laparotomy incision was selected as a highly preferred choice. This could potentially alter the approach to minimally invasive surgery, with the knowledge that patients might prefer a single, concealed, mini-laparotomy to multiple minimally invasive incisions. This will allow physicians to prioritize patient’s concerns about their incisions when planning gynecologic surgeries. As surgeons, it is important to consider and understand our patients' preferences before planning surgery when appropriate.