Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 2/2011

01-02-2011 | Review

The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review

Authors: Kamran Ahmed, Tim T. Wang, Vanash M. Patel, Kamal Nagpal, James Clark, Mariam Ali, Samer Deeba, Hutan Ashrafian, Ara Darzi, Thanos Athanasiou, Paraskevas Paraskeva

Published in: Surgical Endoscopy | Issue 2/2011

Login to get access

Abstract

Objective

This review aimed to determine the role of single-incision laparoscopic surgery (SILS) in abdominal and pelvic operations.

Data sources

The Medline, EMBASE, and PsycINFO databases were systematically searched until October 2009 using “single-incision laparoscopic surgery” and related terms as keywords. References from retrieved articles were reviewed to broaden the search

Study selection

The study included case reports, case series, and empirical studies that reported SILS in abdominal and pelvic operations.

Data extraction

Number of patients, type of instruments, operative time, blood loss, conversion rate, length of hospital stay, length of follow-up evaluation, and complications were extracted from the reviewed items

Data synthesis

The review included 102 studies classified as level 4 evidence. Most of these studies investigated SILS in cholecystectomy (n = 34), appendectomy (n = 24), and nephrectomy (n = 17). For these procedures, operative time, hospital stay, and complications were comparable with those of conventional laparoscopy. Conversion to conventional laparoscopy was seldom performed in cholecystectomy (range, 0–24%) and more frequent in appendectomy (range, 0–41%) and nephrectomy (range, 0–33%).

Conclusion

The potential benefits of SILS include superior cosmesis and possibly shorter operative time, lower costs, and a shortened time to full physical recovery. Careful case selection and a low threshold of conversion to conventional laparoscopic surgery are essential. Multicenter, randomized, prospective studies are needed to compare short- and long-term outcome measures against those of conventional laparoscopic surgery.
Literature
1.
Bucher P et al (2009) Single-port access laparoscopic cholecystectomy (with video). World J Surg 33(5):1015–1019
2.
Desai MM et al (2008) Single-port transvesical simple prostatectomy: initial clinical report. Urology 72:960–965CrossRefPubMed
3.
Gill IS et al (2008) Single-port transumbilical (E-NOTES) donor nephrectomy. J Urol 180:637–641 discussion 641CrossRefPubMed
4.
D’Alessio A et al (2002) One-trocar transumbilical laparoscopic-assisted appendectomy in children: our experience. Eur J Pediatr Surg 12:24–27CrossRefPubMed
5.
Nicholson T, Tiruchelvam V (2001) Comparison of laparoscopic-assisted appendectomy with intracorporal laparoscopic appendectomy and open appendectomy. JSLS 5:47–51PubMed
6.
7.
Valla J et al (1999) Umbilical one-puncture laparoscopic-assisted appendectomy in children. Surg Endosc 13:83–85CrossRefPubMed
8.
Kaouk JH et al (2008) Single-port laparoscopic surgery in urology: initial experience. Urology 71:3–6CrossRefPubMed
9.
Ponsky LE et al (2008) Single-access-site laparoscopic radical nephrectomy: initial clinical experience. J Endourol 22:663–666CrossRefPubMed
10.
Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 55(5):1198–1204
11.
Munro MG (2002) Laparoscopic access: complications, technologies, and techniques. Curr Opin Obstet Gynecol 14:365–374CrossRefPubMed
12.
Roberts KE (2009) True single-port appendectomy: first experience with the “puppeteer technique.” Surg Endosc 23(8):1825–1830
13.
Langwieler TE, Nimmesgern T, Back M (2009) Single-port access in laparoscopic cholecystectomy. Surg Endosc 23(5):1138–1141
14.
Tracy CR et al (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5:561–568CrossRefPubMed
15.
Visnjic S (2008) Transumbilical laparoscopically assisted appendectomy in children: high-tech low-budget surgery. Surg Endosc 22:1667–1671CrossRefPubMed
16.
Desai M (2009) Single-port surgery for donor nephrectomy: a new era in laparoscopic surgery? Nat Clin Pract Urol 6:1CrossRefPubMed
17.
Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 23(6):1393–1397
18.
19.
Flora ED et al (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intraabdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 247:583–602CrossRefPubMed
20.
Giday SA, Kantsevoy SV, Kalloo AN (2006) Principle and history of natural orifice translumenal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 15:373–377CrossRefPubMed
21.
Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293–296CrossRefPubMed
22.
McGee MF et al (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov 13:86–93CrossRefPubMed
23.
Gettman MT, Blute ML (2007) Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery. Mayo Clin Proc 82:843–845CrossRefPubMed
24.
Raman JD et al (2008) Single-incision laparoscopic surgery: initial urological experience and comparison with natural orifice transluminal endoscopic surgery. BJU Int 101:1493–1496CrossRefPubMed
25.
Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate health care interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMed
26.
27.
Kawahara H et al (2006) One-trocar laparoscopy-aided gastrostomy in handicapped children. J Pediatr Surg 41:2076–2080CrossRefPubMed
28.
Mikaelsson C, Arnbjornsson E (1998) Single-puncture laparoscopic gastrostomy in children. Pediatr Surg Int 14:43–44CrossRefPubMed
29.
de la Torre RA et al (2009) Transumbilical single-port laparoscopic adjustable gastric band placement with liver suture retractor. Obes Surg 19(12):1707–1710
30.
Nguyen NT et al (2008) Single-laparoscopic-incision transabdominal (SLIT) surgery adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631CrossRefPubMed
31.
Oltmann SC et al (2009) Single-incision laparoscopic surgery: case report of SILS adjustable gastric banding. Surg Obes Relat Dis 5:362–364CrossRefPubMed
32.
Teixeira J et al (2009) Laparoscopic single-site surgery for placement of adjustable gastric band: a series of 22 cases. Surg Obes Relat Dis 6(1):41–45
33.
Teixeira J et al (2009) Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience. Surg Endosc 23(6):1409–1414
34.
Saber AA, El-Ghazaly TH (2009) Early experience with single-access transumbilical adjustable laparoscopic gastric banding. Obes Surg 19:1442–1446CrossRefPubMed
35.
Reavis KM et al (2008) Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg 18:1492–1494CrossRefPubMed
36.
Saber AA et al (2008) Single-incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg 18:1338–1342CrossRefPubMed
37.
Saber AA, El-Ghazaly TH (2009) Early experience with single-incision transumbilical laparoscopic adjustable gastric banding using the SILS Port. Int J Surg 7(5):456–459
38.
Saber AA, El-Ghazaly TH, Elian A (2009) Single-incision transumbilical laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A 19(6):755–758
39.
Keus F et al (2008) Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis: primary and clinical outcomes. Arch Surg 143:371–377 discussion 377–378CrossRefPubMed
40.
Purkayastha S et al (2007) Laparoscopic cholecystectomy versus minilaparotomy cholecystectomy: a metaanalysis of randomised control trials. Surg Endosc 21:1294–1300CrossRefPubMed
41.
42.
Meining A et al (2007) Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study. Endoscopy 39:860–864CrossRefPubMed
43.
Hodgett SE et al (2008) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13(2):188–192
44.
Cuesta MA, Berends F, Veenhof AA (2008) The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc 22:1211–1213CrossRefPubMed
45.
Zhu JF et al (2008) Totally transumbilical endoscopic cholecystectomy without visible abdominal scar using improved instruments. Surg Endosc 23(8):1781–1784
46.
47.
Nguyen NT et al (2008) Laparoscopic transumbilical cholecystectomy without visible abdominal scars. J Gastrointest Surg 13(6):1125–1128
48.
Rao PP, Bhagwat SM, Rane A (2008) The feasibility of single-port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB Oxford 10:336–340CrossRefPubMed
49.
Chow A et al (2009) Single-incision laparoscopic surgery (SILS) for cholecystectomy: an evolving technique. Surg Endosc 24(3):709–714
50.
Chow A, Purkayastha S, Paraskeva P (2009) Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience. Surg Innov 16(3):211–217
51.
52.
Hernandez JM et al (2009) Laparoendoscopic single-site cholecystectomy: the first 100 patients. Am Surg 75:681–685 discussion 685–686PubMed
53.
Curcillo PG II et al (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24(8):1854–1860
54.
Pelosi MA, Pelosi MA III (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594PubMed
55.
Begin G (1994) Appendicectomie par voie transombelicale vide’oassiste’e. J Coeliochir 11:48–54
56.
57.
Inoue H, Takeshita K, Endo M (1994) Single-port laparoscopy-assisted appendectomy under local pneumoperitoneum condition. Surg Endosc 8:714–716CrossRefPubMed
58.
Ates O et al (2007) Single-port laparoscopic appendectomy conducted intracorporeally with the aid of a transabdominal sling suture. J Pediatr Surg 42:1071–1074CrossRefPubMed
59.
Koontz CS et al (2006) Video-assisted transumbilical appendectomy in children. J Pediatr Surg 41:710–712CrossRefPubMed
60.
Martino A et al (2001) One-trocar surgery: a less invasive videosurgical approach in childhood. J Pediatr Surg 36:811–814CrossRefPubMed
61.
Palanivelu C et al (2008) Transumbilical endoscopic appendectomy in humans: on the road to NOTES: a prospective study. J Laparoendosc Adv Surg Tech A 18:579–582CrossRefPubMed
62.
Varshney S et al (2007) Single-port transumbilical laparoscopic-assisted appendectomy. Ind J Gastroenterol 26:192
63.
Visnjic S, Popovic L, Zupancic B (2006) Laparoscopically assisted appendectomy. Eur Surg Acta Chir Austriaca 38:374–375CrossRef
64.
Cadeddu J et al (2009) Novel magnetically guided intraabdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc 23:1894–1899CrossRefPubMed
65.
Ponsky TA et al (2009) Early experience with single-port laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 19:551–553CrossRefPubMed
66.
Rothenberg SS, Shipman K, Yoder S (2009) Experience with modified single-port laparoscopic procedures in children. J Laparoendosc Adv Surg Tech A 19:695–698CrossRefPubMed
67.
Chouillard E et al (2010) Single-incision laparoscopic appendectomy for acute appendicitis: a preliminary experience. Surg Endosc 24(8):1861–1865
68.
Saber AA et al (2010) Simple technique for single-incision transumbilical laparoscopic appendectomy. Int J Surg 8:128–130CrossRefPubMed
69.
Bucher P, Pugin F, Morel P (2008) Single-port-access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016CrossRefPubMed
70.
Leroy J et al (2008) Single-port sigmoidectomy in an experimental model with survival. Surg Innov 15:260–265CrossRefPubMed
71.
Rieger NA, Lam FF (2009) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surg Endosc 24(4):888–890
72.
Clark JM et al (2008) Video-assisted transumbilical Meckel’s diverticulectomy in children. Am Surg 74:327–329PubMed
73.
Cobellis G et al (2007) One-trocar transumbilical laparoscopic-assisted management of Meckel’s diverticulum in children. J Laparoendosc Adv Surg Tech A 17:238–241CrossRefPubMed
74.
Clayman RV et al (1991) Laparoscopic nephrectomy: initial case report. J Urol 146:278–282PubMed
75.
Raman JD et al (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70:1039–1042CrossRefPubMed
76.
Aron M et al (2008) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103(4):516–521
77.
Desai MM et al (2008) Scarless single-port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int 101:83–88CrossRefPubMed
78.
Desai MM et al (2009) Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology 73:182–187CrossRefPubMed
79.
Garg S, Gundeti M, Mushtaq I (2006) The single-instrument-port laparoscopic (SIMPL) nephrectomy. J Pediatr Urol 2:194–196CrossRefPubMed
80.
Goel RK, Kaouk JH (2008) Single-port-access renal cryoablation (SPARC): a new approach. Eur Urol 53:1204–1209CrossRefPubMed
81.
Winfield HN (2008) Single-port transumbilical (E-NOTES) donor nephrectomy: commentary. J Endourol 22:2417–2418
82.
Hsu THS, Hsu S (2004) A novel open surgical approach to transvesical distal ureterectomy in nephroureterectomy. Int Urol Nephrol 36:155–157CrossRefPubMed
83.
Ismail HR et al (2005) Simultaneous vs sequential laparoscopic bilateral native nephrectomy and renal transplantation. Transplantation 80:1124–1127CrossRefPubMed
84.
Kaouk JH, Goel RK (2009) Single-port laparoscopic and robotic partial nephrectomy. Eur Urol 55(5):1163–1169
85.
86.
Kaouk JH, Palmer JS (2008) Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU Int 102:97–99CrossRefPubMed
87.
Knapp PM Jr, Siegel YI, Lingeman JE (1994) Laparoscopic retroperitoneal needle suspension urethropexy. J Endourol 8:279–284CrossRefPubMed
88.
Rane A (2007) Single-port laparoscopic nephrectomy using a novel laparoscopic port (R-port) and evolution of single laparoscopic port procedure (SLIPP). J Endourol 21(Suppl 1):A1–A292
89.
Rane A, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port). Urology 72:260–263CrossRefPubMed
90.
Ponsky LE et al (2009) A Pfannenstiel single-site nephrectomy and nephroureterectomy: a practical application of laparoendoscopic single-site surgery. Urology 74:482–485CrossRefPubMed
91.
Tracy CR et al (2009) Perioperative outcomes in patients undergoing conventional laparoscopic versus laparoendoscopic single-site pyeloplasty. Urology 74(5):1029–1034
92.
Canes D et al (2009) Laparo-endoscopic single-site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 57(1):95–101
93.
Sotelo R et al (2009) Laparoendoscopic single-site surgery simple prostatectomy: initial report. Urology 74:626–630CrossRefPubMed
94.
Andonian S et al (2010) Laparoendoscopic single-site Pfannenstiel donor nephrectomy. Urology 75:9–12CrossRefPubMed
95.
Bayazit Y et al (2009) Pediatric transumbilical laparoendoscopic single-site nephroureterectomy: initial report. Urology 74:1116–1119CrossRefPubMed
96.
Ganpule AP et al (2009) Laparoendoscopic single-site donor nephrectomy: a single-center experience. Urology 74:1238–1240CrossRefPubMed
97.
Stolzenburg JU et al (2009) Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol 56:644–650CrossRefPubMed
98.
Gill IS (2008) Reply by authors: single port transumbilical (E-NOTES) donor nephrectomy. Gill IS, Canes D, Aron M, Haber G-P, Goldfarb DA, Flechner S, Desai MR, Kaouk JH, Desai MM. J Urol 180:637–641. J Urol 2009;181:419
99.
Raman JD (2008) Reply by authors: single-port transumbilical (E-NOTES) donor nephrectomy. Gill IS, Canes D, Aron M, Haber G-P, Goldfarb DA, Flechner S, Desai MR, Kaouk JH, Desai MM. J Urol 180:637–641. J Urol 2009;181:418–419; author reply 419
100.
Pelosi MA, Pelosi MA III (1992) Laparoscopic supracervical hysterectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:777–784PubMed
101.
Kosumi T et al (2001) Laparoscopic ovarian cystectomy using a single umbilical puncture method. Surg Laparosc Endosc Percutan Tech 11:63–65PubMed
102.
Schenkman L, Weiner TM, Phillips JD (2008) Evolution of the surgical management of neonatal ovarian cysts: laparoscopic-assisted transumbilical extracorporeal ovarian cystectomy (LATEC). J Laparoendosc Adv Surg Tech 18:635–640CrossRef
103.
Ghezzi F et al (2005) One-trocar salpingectomy for the treatment of tubal pregnancy: a “marionette-like” technique. BJOG Int J Obstet Gynaecol 112:1417–1419CrossRef
104.
Massoumi H, Kiyici N, Hertan H (2007) Bile leak after laparoscopic cholecystectomy. J Clin Gastroenterol 41:301–305CrossRefPubMed
105.
Schindlbeck C et al (2008) Comparison of total laparoscopic, vaginal, and abdominal hysterectomy. Arch Gynecol Obstet 277:331–337CrossRefPubMed
106.
Tacchino R, Greco F, Matera D (2008) Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc 23(4):896–899
107.
Naspro R (2008) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence (editorial comment). Eur Urol 55(5):1205–1206
108.
Rassweiler J (2008) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence (editorial comment). Eur Urol 55(5):1205
109.
Mutter D et al (2008) A simple technical option for single-port cholecystectomy. Surg Innov 15:332–333CrossRefPubMed
110.
111.
Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364CrossRefPubMed
112.
Guo W et al (2008) Transumbilical single-port laparoscopic cholecystectomy: a case report. Chin Med J Engl 121:2463–2464PubMed
113.
Romanelli JR et al (2008) Single-port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 15:223–228CrossRefPubMed
114.
Gumbs AA et al (2008) Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 13(3):533–534
115.
Kuon Lee S et al (2009) Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech A 19:495–499CrossRefPubMed
116.
Romanelli JR et al (2009) Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24(6):1374–1379
117.
Rivas H, Varela E, Scott D (2009) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24(6):1403–1412
118.
Schlager A et al (2009) Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy. Surg Endosc 24(7):1542–1546
119.
Kirschniak A et al (2009) Transumbilical single-incision laparoscopic cholecystectomy: preliminary experiences. Surg Laparosc Endosc Percutan Tech 19:436–438CrossRefPubMed
120.
Philipp S, Miedema B, Thaler K (2009) Single-incision laparoscopic cholecystectomy using conventional instruments: early experience in comparison with the gold standard. J Am Coll Surg 209:632–637CrossRefPubMed
121.
Edwards C et al (2010) Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases. Surg Endosc. [Epub ahead of print]
122.
Roberts KE et al (2010) Single-incision laparoscopic cholecystectomy: a surgeon’s initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg 14:506–510CrossRefPubMed
123.
Chow A et al (2010) Single-incision laparoscopic surgery for cholecystectomy: an evolving technique. Surg Endosc 24:709–714CrossRefPubMed
124.
125.
Erbella J Jr, Bunch GM (2010) Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc 24(8):1958–1961
126.
Ersin S, Firat O, Sozbilen M (2010) Single-incision laparoscopic cholecystectomy: is it more than a challenge? Surg Endosc 24:68–71CrossRefPubMed
127.
Rosso RD, Wettstein M, Bruttin JM, Meyer A (1998) Initial experience with laparoscopic-assisted appendicectomy using an umbilical one-trocar technique. Swiss Surg 4:7–9
128.
Satomi ATT, Tanimizu T, Takahashi S, Kawase H, Murai H, Yonekawa H, Takahashi H, Sakai M, Ikeda R, Hinoki A (2001) One-port laparoscopy-assisted appendectomy in children with appendicitis: experience with 100 cases. Pediatr Endosurg Innov Tech 5:371–377CrossRef
129.
Nguyen N et al (2009) A single-port technique for laparoscopic extended stapled appendectomy. Surg Innov 16(1):78–81
130.
Podolsky ER et al (2009) Single port access (SPA) cholecystectomy: two year follow-up. JSLS 13(4):528–535
Metadata
Title
The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review
Authors
Kamran Ahmed
Tim T. Wang
Vanash M. Patel
Kamal Nagpal
James Clark
Mariam Ali
Samer Deeba
Hutan Ashrafian
Ara Darzi
Thanos Athanasiou
Paraskevas Paraskeva
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 2/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1208-6

Other articles of this Issue 2/2011

Surgical Endoscopy 2/2011 Go to the issue

Review

The LapSim virtual reality simulator: promising but not yet proven

OriginalPaper

Long-term follow-up of laparoscopic repair of parastomal hernia using a bilayer mesh with a slit

Editorial

Surgery needs better support from EU

Letter

Does pneumoperitoneum increase or decrease the serum levels of interleukin-6?

Multimedia Manuscript

The fear of transgastric cholecystectomy: misinterpretation of the biliary anatomy

OriginalPaper

Surgical treatment of complicated hepatolithiasis using the ultrasound-guided fiberoptic choledochoscope