Blinded cosmetic comparison of four suture techniques for umbilical reconstruction in TU-LESS

Abstract Background Transumbilical laparoendoscopic single-site surgery (TU-LESS) conceals the incision within the umbilicus, but umbilical hernia, wound infection, and distortion remain concerns, and no consensus exists on the optimal reconstruction technique. We compared four suture techniques for their perioperative and blinded cosmetic outcomes after TU-LESS. Methods This retrospective study included 525 patients who underwent TU-LESS between February 2023 and February 2025. By the operating surgeon’s preference, patients received double figure-of-eight anchoring (group A, n = 133), single figure-of-eight (group B, n = 131), double-U anchoring (group C, n = 129), or continuous suturing (group D, n = 132). Complications, umbilical suturing time, total operative time, and postoperative pain scores were recorded and summarised by technique. Umbilical appearance was assessed at one month postoperatively with the Patient and Observer Scar Assessment Scale (POSAS) by two independent physicians blinded to group allocation, surgeon identity, and timing; the observer scale comprises six items scored 1–10, and the mean item score (lower = better) is reported. Results Complications occurred in 12 of 525 patients (2.29%), with no intergroup difference (all P > 0.05). Umbilical suturing time (7.0 ± 1.7, 5.3 ± 1.3, 6.9 ± 1.8, and 4.5 ± 1.0 min; H = 188.517) and the mean POSAS observer score (3.6 ± 1.1, 3.2 ± 1.0, 3.7 ± 1.2, and 3.0 ± 1.0; F = 11.252) differed significantly across groups (both P < 0.001); continuous and single figure-of-eight suturing were associated with the shortest suturing times and the lowest (best) observer scores. The blinded cosmetic satisfaction rate was 95.4% (501/525), with no intergroup difference (χ²=0.994, P = 0.803). Conclusions All four techniques were used without a technique-specific safety signal in this series. Continuous and single figure-of-eight suturing were associated with the shortest suturing times and the lowest blinded POSAS observer scores. Blinded assessment is warranted, because the surgeons’ unblinded impressions (favouring group A) were inconsistent with the blinded