PD21-03 COSMETIC IMPACT OF PORT VERSUS PORTLESS NEEEDLESCOPIC SURGERY-A PROSPECTIVE, RANDOMIZED, SINGLE-BLINDED STUDY

Abstract

INTRODUCTION AND OBJECTIVES: The use of additional needlescopic instruments may restore triangulation that is lost with pure LESS and NOTES techniques, although the small size of these instruments may limit their functionality. When needlescopic tools are placed through a needlescopic port, the additional size of the port requires a larger more noticeable skin incision. Conversely, if the port is omitted the surgeon may insert a tool of larger diameter and greater functionality. However, if a tool is inserted without a port, the forces created with insertion and withdrawal of this instrument may result in skin shearing and epidermolysis that could worsen cosmesis. The purpose of this study was to characterize the cosmetic impact of needlescopic instrumentation used with and without a port. METHODS: 172 identical grids were tattooed onto the abdomens of female pigs. Grids were randomized to a 2.75mm needlescopic port through which a 2.25mm surgical tool was placed (n=80), a 2.75mm portless needlescopic instrument site (n=80), or a control group without any incisions (n=12). Instruments were manipulated identically for 180 minutes to simulate surgical shearing forces. Cosmesis was evaluated 4 weeks later by a blinded plastic surgeon using a Vancouver Scar Scale (VSS). Sample size was calculated to a power of 0.80 to detect a 20% difference. Fisher's exact and Mann- Whitney tests were used, with p<0.05 considered significant. RESULTS: Average scar size of port and portless sites were 3x2mm with no difference in lengths or widths (p=0.81, p=0.69). Only 31.3%(25/80) of the port sites and 27.5%(22/80) of the port-less sites were identified from 5ft (p=0.73). At close range, there was also no difference in number of visualized scars with 46.3%(37/80) in the port and 45.0%(36/80) in the portless group (p=1.00). Mean VSS scores in the port (0.78) and portless group (0.75) were also similar (p=0.97). CONCLUSIONS: Less than 1/3 of needlescopic ports were detected at 5 ft. by a cosmetic surgeon and omission of the port did not increase scarring. Larger instruments, placed without a port, could improve the functionality of needlescopic surgery without impacting cosmesis.