Transumbilical single-port access cholecystectomy (SPACE) is a feasible technique for operating with less scars and reducing postoperative discomfort at the same time. The transumbilical single-port access for laparoscopic cholecystectomy has multiple benefits, such as better cosmetic results, less wound infections, and less incisional hernias. That is why SPACE is even more appropriate for obese patients. Using one-hand specialized instruments, which are curved at the shaft, and a semiflexible laparoscopic camera (LTFVH, Olympus) will make SPACE more comfortable and more time-saving.

Transanal single port microsurgery is a feasible and new technique for less invasive and more gentle transanal surgery. By using this new multichannel device TEM surgery was changed in a modified way while preserving the anal sphincter.

Nowadays laparoscopy is the approach of choice for the majority of abdominal pathologies. As the emphasis on minimising the technique continues, new methods as natural orifice translumenal endoscopic surgery (NOTES) and, just recently, single port access surgery (SPA) are evolving rapidly. SPA may represent the next generation of minimally invasive surgery as it combines some of the cosmetic advantage of the natural orifice translumenal endoscopic surgery (NOTES) and allows the performance of the surgical procedure with standard surgical instruments. To perform SPA, the abdomen is approached through a 2 cm incision via the umbilicus and a single-port access device is inserted as sole access to the abdomen. Depending on the single-port system, usually a multichannel cannula, two or three laparoscopic instruments can be used at the same time. The special design of the channels prevents gas leakage while changing instruments. There is also an extra channel for the gas insufflation and an additional element for retracting the abdominal wall. Single-port laparoscopic procedures are safe and feasible. Tissue trauma and port-related complications such as organ damage, adhesions, bleedings, wound infections and hernias could be decreased and the cosmesis is comparable with that of NOTES. Additional experience and continued investigation are warranted.

Single-port access surgery (SPA), the most recent development in laparoscopic surgery allows operations to be carried out through only a single incision using special multichannel ports. By the use of a smaller access tissue trauma and access-related complications, such as wound infections, adhesions and incisional hernias can be decreased considerably. Because of less postoperative pain earlier mobilization of patients can also be achieved. By placing the access transumbilically, e.g. in SPA cholecystectomy (SPA-CHE), the scar is perfectly covered achieving an optimal cosmetic result. Meanwhile various so-called single ports and camera systems have been developed. Great importance is attached to the development of special (double) bended and/or articulating instruments because with these instrument triangulation is possible through only one incision. Nevertheless the stereoscopic situation in SPA-CHE implicates some factors related to retraction, exposition and release of the gallbladder but some difficult situations can be managed safely with some tips and tricks.Because of the already worldwide spread of SPA-CHE this technique will soon become an established minimally invasive technique. However, appropriate studies confirming the clear advantages of the technique are still lacking.

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