However, the challenge of obtaining a clean access site thereby preventing intra-abdominal spillage or infection from the incision has not been able to be fully avoided [7]. Additionally the concern over closure of the luminal incision and the lack of a single effective closure technique for stomach, esophagus, or colon, so far limits the application of this technique. http://www.selleckchem.com/products/17-DMAG,Hydrochloride-Salt.html Moreover, the possibility of generating bowel-overdistention due to the pneumoperitoneum required for adequate visualization of intra-abdominal structures is still a concern [5]. With current ongoing research on the efficacy and safety of NOTES it is still premature to advocate it as an alternative to laparoscopic surgery of the biliary tract.

Single-incision laparoscopic surgery or SILS refers to the operative technique in which a surgical procedure is carried out through one incision, alternatively it is also known as laparoendoscopic single site (LESS) surgery. In 1997 Navarra et al. described a single-incision laparoscopic cholecystectomy as a plausible alternative procedure to the four-port laparoscopic cholecystectomy [8]. The use of a single umbilical incision to remove the gallbladder was an interesting innovation and, since Navarra’s initial description, the single-incision laparoscopic cholecystectomy (SILC) procedure has gained momentum. The goals of SILC/LESS cholecystectomy are similar to the goals behind the development of NOTES: decreased pain, decreased length of hospital stay, better aesthetic results, and increased patient satisfaction among others [6, 9].

Multiple articles regarding the use of SILC/LESS cholecystectomy have been published since the initial two studies were published by Bresadola et al. [10] and Piskun and Rajpal [11], leading to a wealth of information regarding the possible adoption of the SILC/LESS cholecystectomy by surgeons worldwide, including a 2010 consensus statement by the Laparoendoscopic Single-Site Surgery Consortium for Assessment and Research (LESSCAR) [9]. It is our goal to review the different SILC/LESS cholecystectomy techniques reported so far along with the results associated with the most recent SILC/LESS cholecystectomy trials. 2. Technical Aspects of Laparoendoscopic Single Site Cholecystectomy Due to the growing experience and development of ports and instrumentation, surgical technique for LESS cholecystectomy is rapidly evolving [21].

A particular technical challenge for the LESS approach Brefeldin_A is limited triangulation due to confinement of both optics and working instruments to a single axis. Researchers and the industry are pursuing solutions to this through the development of next-generation instruments (Angled, flexible, articulated, and motorized) [9]. Given this, there is a wide variation of methods regarding the type of ports, trocars, optics, instruments, and methods to expose and dissect the gallbladder (Table 1).