Patient preferences for surgical techniques: should we invest in new approaches? Ahsan Rao • James Kynaston • Euan R. MacDonald • Irfan Ahmed Received: 17 November 2009 / Accepted: 10 March 2010 Ó Springer Science+Business Media, LLC 2010 Abstract Background The face of surgery has changed over the past two decades with the introduction of laparoscopic techniques. The majority of surgical specialties now per- form minimally invasive procedures hence decreasing the scarring, pain, and infection historically associated with open surgery. To further reduce the invasiveness of sur- gery, new surgical techniques like Natural Orifice Trans- luminal Endoscopic Surgery (NOTES) and Single-Port Surgery (SPS) are under development. Despite investment from the medical device industry and enthusiasm from medical professionals, we must analyse patient preferences and expectations of these novel techniques. This analysis will help us establish the demand for such techniques and guide future resource allocation. Methods A questionnaire-based study was derived to identify whether the concepts of innovative techniques are acceptable to the general population. Their preferences between different available surgical options were recorded along with their choices for new innovative techniques. This study was carried out face-to-face and by using an online survey. It comprised four questions based upon a hypothetical scenario of an acute appendicitis. All the data were captured in a prospective database and analysed using statistical software. Results A total of 750 participants from variable back- grounds took part in the study. NOTES or SPS without an established safety profile was accepted by 34.3% of patients. SPS was the most popular method followed by conventional laparoscopy. Open surgery and NOTES were the least pre- ferred (ranked 1.78, 1.98, 2.94, and 3.27, respectively). Choosing between SPS and NOTES only, 80.6% opted for SPS, 11.8% NOTES, and 5.6% declined surgery. The most popular route of access for NOTES is oral (37.7%). Conclusion Single-port surgery was the most preferred method and NOTES was the least preferred technique. This shows general acceptance of the concept of virtually scarless surgery but without using the natural orifices. Keywords Scarless surgery Á Single port Á Laparoscopy Á Open surgery Á Appendectomy Successful introduction of laparoscopic surgery in 1987 has changed the face of surgical specialties [1]. Minimally invasive surgical techniques have now reduced the scar- ring, pain, and wound problems historically associated with open surgery. Surgeons’ quest to improve patient care by reducing scarring has continued to push the boundaries. An interesting concept of using natural orifices for access to the peritoneal cavity has been researched for the past few years from which the term NOTES (Natural Orifice Transluminal Endoscopic Surgery) has been coined. Medical and media interest has pushed the medical device manufacturing industry to make considerable investment into developing equipment to make it possible. Research is ongoing to find a safe way to open and close a normal viscus through which the instruments can be introduced into the peritoneal cavity to carry out a surgical procedure. A. Rao (&) Á J. Kynaston Á E. R. MacDonald Á I. Ahmed Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen AB25 2ZA, UK e-mail: a.rao.03@aberdeen.ac.uk I. Ahmed (&) Department of Surgery, Ward 31. Foresterhill, Aberdeen Royal Infirmary, Aberdeen AB25 2ZA, UK 123 Surg Endosc DOI 10.1007/s00464-010-1078-y