Laparoscopic cholecystectomy has been recognized since 1992 as the gold standard procedure for gallbladder surgery. The authors propose a single-incision laparoscopic (SILS) cholecystectomy as a step toward less invasive surgical procedures. A single intraumbilical 12-mm incision is made, and the umbilicus is pulled out, exposing the fascia. Pneumoperitoneum is induced with the Versastep Veress access needle. A 5-mm trocar then is introduced, and the abdominal cavity is explored with a 5-mm 30 degrees optic. Second and third trocars are introduced respectively at the left and right sides, near the first trocar. Two sutures are used to suspend the gallbladder and to ensure optimal exposure of the Triangle of Calot. Dissection is performed as a normal retrograde cholecystectomy using an Endoshear roticulator in the left trocar and an Endograsp roticulator in the right hand. The cystic artery and cystic duct are clipped separately with a standard 5-mm clip applier and then excised. The gallbladder is removed through the umbilical incision. Of the 12 patients who underwent SILS cholecystectomy without major complications, 8 had previously undergone other laparoscopic surgeries. The body mass index (BMI) exceeded 35 in three cases. Operative time decreased and stabilized from the first 3-h SILS cholecystectomy to approximately 50 min after the first five cases. At this writing, the authors find SILS cholecystectomy to be feasible, safe, and effective.

Background: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective: To report a large multi-institutional worldwide series of LESS in urology. Design, Setting, And Participants: Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Intervention: Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Measurements: Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Results and Limitations: Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160 ± 93 min. and estimated blood loss was 148 ± 234 mL. Skin incision length at closure was 3.5 ± 1.5cm. Mean hospital stay was 3.6 ± 2.7 d with a visual analog pain score at discharge of 1.5 ± 1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/ robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. Conclusions: This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.

Despite initial skepticism, this study, together with many other large-scale, long-term similar studies from around the world (e.g., Taiwan, United States, France, Spain, India, Lebanon) demonstrated the MGB to be a short, simple, low-risk, effective, and durable bariatric procedure.

Our results confirm MGB/OAGB to be a reliable bariatric procedure. According to other large and long-term published series, MGB/OAGB seems to compare very favorably, in terms of complication rate, with two mainstream procedures as standard Roux-en-Y gastric bypass (RYGBP) and laparoscopic sleeve gastrectomy (LSG).

OBJECTIVETo compare the last generation of 3-dimensional imaging (3D) vs standard 2-dimensional imaging (2D) laparoscopy. MATERIALS AND METHODSA prospective observational study was conducted during the 4th Minimally Invasive Urological Surgical Week Course held in Braga (Portugal) in April 2013. The course participants and faculty were asked to perform standardized tasks in the dry laboratory setting and randomly assigned into 2 study groups; one starting with 3D, the other with 2D laparoscopy. The 5 tasks of the European Training in Basic Laparoscopic Urological Skills were performed. Time to complete each task and errors made were recorded and analyzed. An end-of-study questionnaire was filled by the participants. RESULTSTen laparoscopic experts and 23 laparoscopy-naïve residents were included. Overall, a significantly better performance was obtained using 3D in terms of time (1115 seconds, interquartile range [IQR] 596-1469 vs 1299 seconds, IQR 620-1723; P ¼ .027) and number of errors (2, IQR 1-3 vs 3, IQR 2-5.5; P ¼ .001). However, the experts were faster only in the "peg transfer" task when using the 3D, whereas naïves improved their performance in 3 of the 5 tasks. A linear correlation between level of experience and performance was found. Threedimensional imaging was perceived as "easier" by a third of the laparoscopy-naïve participants (P ¼ .027). L aparoscopy has been increasingly adopted in urology over the last 2 decades, and it is nowadays commonly used in the management of several urologic diseases. Traditionally, laparoscopy has been based on 2-dimensional (2D) imaging, which has represented a considerable challenge for those approaching this technique.1 Thus, 3-dimensional (3D) visualization technology for laparoscopy has been proposed, since the early 1990s, as a way to facilitate laparoscopic performance. However, early 3D laparoscopic technology was limited in terms of image quality, so that its use had not been implemented. 2More recently, industry has developed novel 3D systems where the imaging is similar to stereoscopic vision, in which the depth perception is achieved by different unique images received by each eye. Thus, more recent studies have suggested a possible advantage provided by these new 3D systems during laparoscopic performance.3-5 However, comparative assessments of new generation 3D vs 2D laparoscopy remain limited, especially in the urology field.