To compare the cosmetic appeal of incisions used for open (Pfannenstiel or Vertical midline) versus robotic-assisted laparoscopic lower urinary tract reconstructive surgery in women. It is often assumed that the minimally invasive “keyhole” robotic-assisted approach leads to favourable cosmetic outcomes for patients.  However, robotic-assisted laparoscopic surgery requires multiple small abdominal incisions in highly visible areas of the abdomen.

Our study involved administering a brief survey (descriptive) to women in our outpatient urology clinic . Patients were provided illustrations of A) Pfannenstiel incision (incision at “bikini line”); B) Vertical midline laparotomy incision (incision from midline symphysis to umbilicus); C) Robotic-assisted laparoscopic incisions – variation 1 [9] and D) Robotic-assisted laparoscopic incisions – variation 2 [10].  Patients were asked to rate each incision  based on its cosmetic appeal in order of preference.  Demographic data was collected regarding patient age, BMI, occupation and surgical history (existing abdominal scars).  Chi square distribution was used to compare mean previous surgeries and no previous surgeries between different preferred incisional groups and ages of the patients.

Open incisions are preferred over robotic incisions.Descriptive statistics including ranks, means and medians were used to summarise results.   We have compared proportions of different demographic groups regarding their preferred incision using a chi-square test.  P values < 0.05 will be considered significant.

One hundred patients with mean age were 53.11±15.05 years with minimum 19 years and maximum 84 years and mean BMI was 28.18±7.05 kg/m2 with minimum 15.6 and maximum 55 kg/m2 calculated. Out of 100 patients (1st preference of incision), 78% preferred incision A Pfannenstiel incision (incision at “bikini line”); 3% preferred B incision Vertical midline laparotomy incision (incision from midline symphysis to umbilicus); and 16% & 3% patients preferred incision C Robotic-assisted laparoscopic incisions-variation I  and D Robotic-assisted laparoscopic incisions-variation II respectively. Similarly (2nd preference of incision) 3% patients preferred incision A, 19% preferred B incision and 56% & 22% patients preferred incision C and D respectively. The mean comparison between first preferred incision with second preferred incision with respect of surgeries (previous surgeries and no previous surgeries) showed significant difference p≤0.05 (chi value=167.692, p=0.000). Relation of preferred incisions with respect to ages of the patients showed no significant difference (Pearson relation value -0.182 and p=0.069).

Overall, open incisions were preferred over robotic incisions. Patient perception of the "visibility" of abdominal incisions and previous experience in term of surgical scars may be the distinguishing issue to explain the difference in the preferences between open versus robotic-assisted laparoscopic incisions in women.

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