Exclusion criteria for minimally invasive approach were the same of traditional laparoscopic surgery. Clinical or radiological signs of complicated appendix or gallbladder disease (masses and abscesses) and of voluminous neoplasms, the presence of liver cirrhosis, peritonitis, previous upper abdominal Imatinib chemical structure surgery, or severe obesity were exclusion criteria for SILS. 2.2. Single-Port Access Technique: Surgical Glove Port Construction An access device was made by a standard wound protector (a small size or extra small size ALEXIS wound retractor; Applied Medical, CA, USA) (Figure 1) and size 6, nonlatex sterile glove. The wound retractor was introduced through the small umbilical incision. The surgical glove was fixed to the outer ring of the wound retractor (Figure 2).

A little access was made on the tip of one finger, and the CO2 pipe was connected to induce pneumoperitoneum (Figure 3). Other accesses were made on the others fingers to create a working channel for the laparoscopic instruments (Figure 4). Five- or three-millimeter traditional or curved laparoscopic instruments were used. Figure 1 Placement of wound protector. Figure 2 Placement of surgical glove. Figure 3 Induction of pneumoperitoneum. Figure 4 Placement of instruments. 3. Results SILS was successfully completed in 34 patients: 20 appendectomy was performed in female patients (median age 15, range 9�C32 years), cholecystectomy in 12 patients (11 female and 1 male, median age 35, range 17�C83 years), and right hemicolectomy in 2 female patients (55 and 64 years old).

In no patient conversion to standard laparoscopy or to open surgery was needed. The median operative time for appendectomy, cholecistectomy and right hemicolectomy was 35, 45, and 67.5 minutes, respectively. Blood loss was minimal in all cases. No wound complication occurred; a picture of the scare at the end of a procedure is showed in the Figure 5. Figure 5 The umbilical scare at the end of a procedure. The postoperative course was uneventful in all patients. The median postoperative in-hospital stay was 2 days for appendectomy and cholecistectomy and 6 days for right hemicolectomy. The characteristics of patients and the perioperative results are resumed in Table 1. Table 1 Patients and perioperative results. An analytical analysis of postoperative pain was not performed; however, no patient needed any opiates drugs and no discharged was conditioned by sorrow.

In right hemicolectomy, the resection margins were oncologically correct and the number of regional limphonodes was adequate: in the surgical specimen of the first patient, 17 limphonodes were found with 2 micrometastases; in the second patient, Brefeldin_A 14 limphonodes were found without any sign of disease. An adequate preoperative staging was performed: thoracic and abdominal CT with contrast enhancement and colonoscopy excluded, respectively distant metastases and other cancer colonic localization. An analysis of costs of this technique was made too.