Tim Goodacre

Patients' health related quality of life before and after aesthetic surgery

OBJECTIVES To assess the health related quality of life of patients before and after aesthetic surgery. DESIGN A survey by questionnaire of patients before receiving surgery and 6 months after surgery. SAMPLE 656 patients anticipating surgery were sent a preoperative questionnaire, to which 443 replied. Subsequently 259 of these received a postoperative questionnaire, of which 198 were returned. OUTCOME MEASURES Health status was assessed using three standardised health status instruments (The Short Form 36 Health Survey Questionnaire (SF-36), the General Health Questionnaire (GHQ-28) and the Rosenberg Self Esteem Scale. Comparisons were made between the health status of the plastic surgery patients and that of a random sample of the general population. RESULTS Patients receiving breast reduction surgery experienced significant improvements on all three health status measures. Patients in all surgical groups experienced significant improvements in self-esteem. CONCLUSIONS Patients receiving aesthetic surgery experience a wide range of physical, psychological and social problems. Surgery was shown be effective at addressing these problems. Health status assessment provides a valid and independent method for measuring the effects of such health care interventions.

Measuring Outcomes in Craniofacial and Pediatric Plastic Surgery

This article discusses the measurement of outcomes in craniofacial and pediatric plastic surgery, using examples of craniosynostosis and cleft lip and/or palate (CLP). The challenges in measuring the standard outcomes of function, aesthetics, and health-related quality of life are discussed, along with the importance of developing evidence and studying quality improvement in this specialty. The need to define specific and comprehensive goals is discussed with a focus on patient-reported outcomes (PROs). Examples from the development of the CLEFT-Q, a PRO instrument for patients with CLP, are provided to support the need to seek the patient perspective.

Occasional reviewCleft lip and palate: current management

Cleft lip and palate are the most common presenting congenital conditions of the face and cranial bones. This article describes current understanding of the aetiology and presentation of the deformity and management of the child from prenatal diagnosis until maturity. Principle concerns include correction of the physical defect with the best possible functional and cosmetic outcome, optimal speech correction, satisfactory feeding and hearing, and dental and orthodontic health. The value of comprehensive management of all aspects of care within a multidisciplinary team including clinical psychology support for child and family is discussed.

Trans-oral robotic cleft surgery (TORCS) for palate and posterior pharyngeal wall reconstruction: A feasibility study

BACKGROUND/AIM Robot-assisted surgery has become increasingly routine, replacing open and laparoscopic techniques in certain domains, with recent extension to head and neck surgery through trans-oral access. Some advantages of the robot-assisted surgery include the ability to access confined spaces, enhanced dexterity instrumentation with intuitive movement, motion scaling, tremor elimination and three-dimensional (3D) endoscopic viewing with true depth perception. The aim of this study was to investigate the technical feasibility of trans-oral robotic cleft surgery (TORCS) to access the posterior pharyngeal wall and palate for potential use in the cleft population. METHODS All possible permutations of patient and robotic instrument configurations were used with the daVinci Si Surgical System® (Intuitive Surgical, USA) 0° and 30° 3D endoscopes and 8-mm training instruments to determine the optimal visualization and surgical access to the palate and posterior pharynx in a paediatric airway manikin, and to simulate posterior pharyngeal wall surgery. A full robot-assisted cadaveric Hynes pharyngoplasty was performed using 5-mm training instruments. Experiments were recorded with still and video photography. RESULTS TORCS is technically feasible in the paediatric cleft population. We predict a short learning curve due to the intuitive instrumentation, easier dissection and the potential to limit secondary insult compared with traditional surgery, as well as improved ergonomics for the operating surgeon. CONCLUSIONS The as-yet unreported use of robotic-assisted cleft palate surgery may considerably enhance a surgeons ability to perform difficult procedures of the palate and posterior pharynx in selected patients with limited access as well as lay the foundation for potential novel techniques.