Cognition and experience of surgical incisions in patients undergoing laparoscopic surgery with enhanced recovery after surgery protocol: A qualitative study

Enhanced recovery after surgery (ERAS) protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma. However, the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored, particularly in non-Western populations. This study aims to explore patients’ perceptions and preferences regarding laparoscopic incisions under ERAS, providing evidence to optimize incision planning and perioperative education. A qualitative descriptive study was conducted at the Department of Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between November 2022 and February 2023. The participants were adults (≥18 years) who underwent elective laparoscopic abdominal surgery under ERAS, excluding those with cognitive impairments, language barriers, or emergency procedures. Semi-structured interviews, covering physical function, social function, emotional function, self and others’ acceptance, and confidence in the nature and treatment of the disease, were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons, nurses, and psychologists. The data were analyzed via the framework method to identify themes related to incision experiences. This qualitative study included 16 participants, 8 (50%) females and 6 (37.5%) cancer patients, with a mean age of 41.5 ± 12.2 years. Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location, size, and cosmetic appearance of the incision. They also voiced high expectations for preventing incision complications and sought information regarding postoperative care. There was notable variation in preferences regarding the choice of incision site before surgery. Participants with cancer focused on disease cure rather than aesthetics. Personalized preoperative discussions, incision site selection, and postoperative education are critical for increasing patient satisfaction. Laparoscopic incisions under ERAS minimally impact psychological well-being, but location-specific discomfort and aesthetic preferences require attention.