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Consumer demand for surgical innovation: a systematic review of public perception of NOTES

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Abstract

Background

The full scope of benefits offered by NOTES over traditional laparoscopy, if any, is not yet fully clear. Perceived patient demand for truly “scarless surgery” is often referenced one of the driving factors in the continued development of this relatively new technique. The true scale of patient preference and demand for NOTES as a surgical technique is unknown. This review aims to summarise currently available literature on the topic of patient perceptions of NOTES to guide future development of the technique.

Methods

A comprehensive search of PubMed and Web of Science electronic databases was performed on 1st Jan 2014. To be considered for inclusion, articles were required to assess and report the perception of NOTES in a sample of laypersons (patients or general public). The primary endpoint assessed was acceptance or preference rates expressed by patients for NOTES procedures. Reasons given for preference or rejection of NOTES were recorded, as well as preferred access routes and any predicting factors of NOTES acceptance.

Results

Initial search returned 1,334 results, resulting in 15 articles included in final data synthesis. These polled a total of 4,420 subjects. Acceptance of NOTES ranged between 41 and 84 %. Compared to a laparoscopic approach, preference rates for NOTES ranged from 0 to 78 %. Reasons for preferring NOTES were largely centred on potentially reduced recovery time, complications (particularly with reference to hernias) and postoperative pain. Improved cosmesis also played a role, but was secondary to the above issues. Overall, study quality was poor.

Conclusions

This review suggests significant public interest in NOTES and scarless surgery in general. Further research and consideration of differences in public perceptions across regions, countries and cultures are required.

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Disclosures

Drs Pucher, Sodergren, Lord, Teare, Yang and Darzi have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, St Mary’s Hospital, Imperial College London, London, W2 1NY, UK

    Philip H. Pucher, Mikael H. Sodergren & Ara Darzi

  2. Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK

    Mikael H. Sodergren, Guang-Zhong Yang & Ara Darzi

  3. Department of Surgery, Southampton General Hospital, London, UK

    Amy C. Lord

  4. Department of Gastroenterology, St Mary’s Hospital, Imperial College London, London, UK

    Julian Teare

  5. Department of Biosurgery and Surgical Technology, St. Mary’s Hospital, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK

    Mikael H. Sodergren

Authors
  1. Philip H. Pucher
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  2. Mikael H. Sodergren
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  3. Amy C. Lord
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  4. Julian Teare
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  5. Guang-Zhong Yang
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  6. Ara Darzi
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Correspondence to Mikael H. Sodergren.

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Pucher, P.H., Sodergren, M.H., Lord, A.C. et al. Consumer demand for surgical innovation: a systematic review of public perception of NOTES. Surg Endosc 29, 774–780 (2015). https://doi.org/10.1007/s00464-014-3769-2

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  • DOI: https://doi.org/10.1007/s00464-014-3769-2

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