The first laparoscopic cholecystectomy was performed by M��he [4] however his approach did not become popular until both French MEK162 price and American groups popularized the four-port technique in the early 1990s. The idea of minimally invasive surgery for the removal of the gallbladder had now become a plausible technique that was rapidly accepted as the standard-of-care. Patients quickly learned of the new procedure and began to request it on the basis of a shorter hospital stay, less pain, and smaller scars [5]. The possibility of performing laparoscopic cholangiography, common bile duct exploration, and choledochotomy expanded the role of laparoscopic surgery in the treatment of biliary disease [6] and further advanced the idea of minimally invasive surgery as the gold-standard for surgery of the biliary tract.

Recently the development of natural orifice transluminal endoscopic surgery (NOTES) opened the field of incision-less surgery. The main goal of NOTES is to eliminate the need for skin incisions along with other theoretical advantages which include: decreased postoperative pain, performing procedures in the out-patient setting, reduced incidence of hernias, reduced hospital stay, and increased overall patient satisfaction [5, 7]. The idea of accessing internal organs through the wall of the vagina, colon, stomach, bladder, and so forth, with the use of rigid or flexible instruments is an attractive one. However, the challenge of obtaining a clean access site thereby preventing intra-abdominal spillage or infection from the incision has not been able to be fully avoided [7].

Additionally the concern over closure of the luminal incision and the lack of a single effective closure technique for stomach, esophagus, or colon, so far limits the application of this technique. Moreover, the possibility of generating bowel-overdistention due to the pneumoperitoneum required for adequate visualization of intra-abdominal structures is still a concern [5]. With current ongoing research on the efficacy and safety of NOTES it is still premature to advocate it as an alternative to laparoscopic surgery of the biliary tract. Single-incision laparoscopic surgery or SILS refers to the operative technique in which a surgical procedure is carried out through one incision, alternatively it is also known as laparoendoscopic single site (LESS) surgery. In 1997 Navarra et al. described a single-incision laparoscopic cholecystectomy as a plausible alternative procedure to the four-port laparoscopic cholecystectomy [8]. The use of a single umbilical incision to remove the gallbladder was an interesting innovation and, Dacomitinib since Navarra’s initial description, the single-incision laparoscopic cholecystectomy (SILC) procedure has gained momentum.