title: Laparoendoscopic Single-Site Cholecystectomy: First Experiences with a New Standardized Technique Replicating the Four-Port Technique.
abstract: BACKGROUND
  After reports on laparoendoscopic single-site (LESS) cholecystectomy, concerns have been raised over the level of difficulty and a potential increase in complications when moving away from conventional gold standard multiport laparoscopy due to incomplete exposure and larger umbilical incisions. With continued development of technique and technology, it has now become possible to fully replicate this gold standard procedure through an LESS approach. First experiences with the newly developed technique and instrument are reported.
  
  
  METHODS
  Fifteen patients presenting with cholelithiasis without signs of inflammation were operated using all surgical steps considered appropriate for the conventional four-port laparoscopic approach, but applied through a single access device. Operation-centered outcomes are presented.
  
  
  RESULTS
  There were no peri- or postoperative complications. Mean operating time was 32.3 minutes. No conversion to regular laparoscopy was required. The critical view of safety was achieved in all cases. Mean skin incision length was 2.2 cm.
  
  
  CONCLUSIONS
  The application of a standardized technique combined with the use of a four-port LESS device allows us to perform LESS cholecystectomy, giving us a correct exposure of the structures and without increasing the mean operating time combining previously reported advantages of LESS. A universal trait of any new technique should be safety and reproducibility. This will enhance its applicability by large number of surgeons and to large number of patients requiring cholecystectomy.
authors: 1 Virgen del Rocío University Hospital , Innovation and Minimal Invasive Surgery Unit, Seville, Spain .
authors: Salvador
authors: S
authors: Morales-Conde
authors: 2 Virgen de Valme University Hospital , Colorectal Surgery Unit, Seville, Spain .
authors: Jesús
authors: J
authors: Cañete-Gómez
authors: 1 Virgen del Rocío University Hospital , Innovation and Minimal Invasive Surgery Unit, Seville, Spain .
authors: Virginia
authors: V
authors: Gómez
authors: 1 Virgen del Rocío University Hospital , Innovation and Minimal Invasive Surgery Unit, Seville, Spain .
authors: María
authors: M
authors: Socas Macías
authors: 1 Virgen del Rocío University Hospital , Innovation and Minimal Invasive Surgery Unit, Seville, Spain .
authors: Antonio Barranco
authors: AB
authors: Moreno
authors: 1 Virgen del Rocío University Hospital , Innovation and Minimal Invasive Surgery Unit, Seville, Spain .
authors: Isaias Alarcón
authors: IA
authors: Del Agua
authors: 1 Virgen del Rocío University Hospital , Innovation and Minimal Invasive Surgery Unit, Seville, Spain .
authors: Francisco Javier Padillo
authors: FJ
authors: Ruíz
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology
keywords: LESS cholecystectomy; cholelithiasi; gallbladder; minimally invasive cholecystectomy