title: Supra-pubic single incision cholecystectomy.
abstract: BACKGROUND
  Surgery is moving towards less invasive and cosmetically superior approaches such as single incision laparoscopy (SIL). While trans-umbilical SIL is gaining popularity, incisions may lead to post-operative deformations of the umbilicus and the possibility of an increased rate of incisional hernias. Access within the pubic hairline allows preservation of the umbilicus and results in a scar which is concealed within the pubic hair.
  
  
  METHODS
  Supra-pubic single incision cholecystectomy was performed in a 30-year-old patient with symptomatic gallstones. A 2.5-cm transverse incision was placed within the pubic hairline and a subcutaneous tunnel was formed. Three 5-mm ports were introduced into the tunnel and perforated the anterior rectus sheath superior to the skin incision. The surgical procedure was then undertaken with conventional laparoscopic instrumentation. The adjacent 5-mm incisions were merged for gallbladder removal. The entry site was closed under direct vision.
  
  
  RESULTS
  The above procedure was technically feasible and without complication. Operative time was 45 min, and the patient was discharged 5 h post-operatively.
  
  
  CONCLUSIONS
  Supra-pubic single incision laparoscopic cholecystectomy may offer a more cosmetically appealing result than standard umbilical access. The operation can be performed by surgeons skilled in single incision techniques with good result.
authors.affiliation: Department of Surgery, Center for the Future of Surgery, University of California, San Diego, CA 92108, USA. MonikaHagen@aol.com
authors.forename: Monika E
authors.initials: ME
authors.lastname: Hagen
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Wagner
authors.forename: Kari
authors.initials: K
authors.lastname: Thompson
authors.forename: Garth
authors.initials: G
authors.lastname: Jacobsen
authors.forename: Adam
authors.initials: A
authors.lastname: Spivack
authors.forename: Brian
authors.initials: B
authors.lastname: Wong
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D014741:Video Recording