title: Combined laparoendoscopic single-site surgery: initial experience of a single center.
abstract: OBJECTIVE
  This study reports the initial experience with combined laparoendoscopic single-site surgery (LESS) referring to cholecystectomy, appendectomy, oophorocystectomy and liver cyst and renal cyst fenestration and explore the feasibility and safety of combined LESS.
  
  
  METHODS
  From October 2008 to May 2011 selective 24 patients underwent combined LESS in our center. The single incision in umbilicus was about 2cm. All the operations were performed by the same surgical team and used conventional rigid instruments.
  
  
  RESULTS
  In 24 patients, combined laparoendoscopic single-site cholecystectomy and appendectomy were performed in 17 cases, combined cholecystectomy and liver cyst fenestration in 5 cases and combined cholecystectomy and oophorocystectomy in 2 cases. Twenty one patients were successfully operated and the other 3 were converted to conventional laparoscopic surgery because of separating Calot's triangle difficulty. The mean operating time was 87.3 minutes. One urinary retention (4.2%) and one fat liquefaction in abdominal incision (4.2%) occurred and were cured conservatively. There was no mortality in the study.
  
  
  CONCLUSIONS
  Combined laparoendoscopic single-site surgery is safe, feasible, minimally invasive and cosmetic technique but is more difficult than conventional laparoscopic surgery. It is a reasonable alternative to be performed in selective patients by experienced laparoscopic surgeons.
authors.affiliation: Department of Surgery, Tianjin Medical University, Tianjin, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Cai
authors.forename: Juan
authors.initials: J
authors.lastname: Xu
authors.forename: Mingwei
authors.initials: M
authors.lastname: Zheng
authors.forename: Mingfang
authors.initials: M
authors.lastname: Qin
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Zhao
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003560:Cysts / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures