4. Results None of the patients required an open operation. Twenty-nine patients underwent successful single-port laparoscopic make it clear cholecystectomy. We had to add another port to finish the procedure in a 60-year-old female patient with a resolving biliary pancreatitis because pancreatic head edema obscured safe visualization of the critical view of the Calot’s triangle. There were more female than male patients in this study, as expected by the nature of the disease (22 women and 8 men; M:F 2.75:1) (Table 1). The mean age of the patients was 46 years (range, 24�C96 years), and mean BMI was 30.6kg/cm2 (range, 19.5�C41kg/cm2). The mean operative time, skin to skin, was 104min (Figure 2). The estimated blood loss in all patients was ��50g. There were no intraoperative complications. Average pain score was 3.

2 �� 1.1 postoperatively. The length of the post-operative hospital stay was 2 �� 1 days. There was no wound infection, and no mortality was observed. Figure 2 Length of SILS cholecystectomy. Table 1 Summary of patient characteristics. One patient had to be readmitted for continuous postoperative abdominal pain which was found to be attributable to a bile collection at the gall bladder fossa. The patient underwent ERCP which delineated a missed accessory bile duct in the gall bladder fossa (duct of Luschka). The problem was managed with a temporary stenting of the common bile duct. No injuries to the main biliary tree were recorded in this series. All umbilical incisions were concealed within the umbilicus. There were no records of umbilical wound drainage or infection in the short-term followup.

All patients were followed for 12 months. There was no umbilical hernia recorded. Cosmetic outcomes at followup were excellent with a minimal, barely visible scar in most patients (Figure 3). Figure 3 Views of umbilical scar after surgery. 5. Discussion In the recent years, laparoscopic surgery has developed rapidly. Although Navarra and colleagues [4] reported SILC 14 years ago, the procedure did not gain wide acceptance until a decade later because of great technical progress and remarkable improvements in the handling of the instruments and visualization. Single-incision laparoscopic surgeries are increasingly described as potentially less invasive, ��stealth�� procedures and have recently been performed for many intra-abdominal pathologies such as appendectomy [15], adrenalectomy [16], gastric banding [17], and donor nephrectomy [18].

Cholecystectomy is a procedure with a low morbidity rate worldwide. An important factor with laparoscopic approaches to the gallbladder is the ability for the surgeon to obtain a ��critical view of the Calot’s triangle.�� Most surgeons who routinely perform laparoscopic cholecystectomy would consider the critical view as a Brefeldin_A basic requirement and would be greatly concerned by any new technique that compromised it. Departure from some of the basic tenets of laparoscopic surgery is a major disadvantage of this operation.