title: Laparoscopic transumbilical cholecystectomy without visible abdominal scars.
abstract: BACKGROUND
  We present a novel surgical technique for cholecystectomy utilizing three laparoscopic ports placed through the umbilicus. This new method is natural orifice transumbilical surgery (NOTUS) and describes a laparoscopic operation that can be performed with all incisions placed within the umbilicus obviating visible abdominal scars.
  
  
  OBJECTIVE
  To develop a novel laparoscopic surgical technique for cholecystectomy utilizing only transumbilical incisions. Natural orifice translumenal endoscopic surgery (NOTES) has become an exciting area of surgical development. Significant limitations to this surgical concept, however, are lack of surgical expertise and appropriate flexible instrumentation. An alternative and competing technology to NOTES is NOTUS.
  
  
  METHODS
  We describe a patient in whom a laparoscopic surgical technique for cholecystectomy utilized incisions all placed entirely within the umbilicus. This new technique is called NOTUS and describes a laparoscopic operation that can be performed without visible abdominal scar.
  
  
  RESULTS
  The operative time was 70 min. There were no intraoperative complications. The patient did well postoperatively and was discharged on the same operative day. There were no postoperative complications at 2 months follow-up.
  
  
  CONCLUSIONS
  Cholecystectomy performed through laparoscopic incisions placed within the umbilicus was technically feasible and safe in our patient. Development of advanced flexible instrumentation and visualization platforms may facilitate this new operative approach. Further advantages of NOTUS cholecystectomy compared to conventional laparoscopic cholecystectomy will ultimately require a randomized clinical trial.
authors: Department of Surgery, University of California Irvine Medical Center, 333 City Blvd. West, Suite 850, Orange, CA 92868, USA. ninhn@uci.edu
authors: Ninh T
authors: NT
authors: Nguyen
authors: Kevin M
authors: KM
authors: Reavis
authors: Marcelo W
authors: MW
authors: Hinojosa
authors: Brian R
authors: BR
authors: Smith
authors: Samuel E
authors: SE
authors: Wilson
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002921:Cicatrix / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*