The value of cosmesis: When LESS is more

The concern is that performing surgery through a 2- to 4-cm incision might risk poor surgical outcomes. Numerous articles suggest that this is not the case, at least when performed by very experienced surgeons in carefully selected patients. As such, the debate about LESS versus multi-port laparoscopy needs to evolve. We no longer need to consider if LESS is safe and effective-with the caveat of experienced hands-but we do need to examine in whom the cosmetic advantages of LESS merit the added surgical complexity.

In this issue of Urology Times, an important contribution from the University of Texas Southwestern Medical Center and the University of Iowa informs this debate. These urologists have been leaders in developing LESS, and now they are helping to clarify its role. Using a questionnaire ranking various surgical outcomes, these investigators found that surgical scarring was low on the list of patients' priorities.

We need to go even further than this, though. It would be incorrect to assume that LESS always provides a better cosmetic outcome than multi-port laparoscopy, especially if the latter is modified using smaller ports that are strategically placed. There are validated questionnaires that can be used to compare scars and body image perception, and we should use these to truly determine which procedures provide the cosmetic results we think we are providing.

Dr. Wolf, a member of the Urology Times Editorial Council, is professor of urology at the University of Michigan, Ann Arbor.